Podcast Show Notes

Our podcast discussion today between Michael Andrade  and James Napoli, CEO of MedLiminal.   During this time of unprecedented financial uncertainty it’s more important than ever that Plan Sponsors have more fiscal control over their payment integrity process.  New legislation is emerging on how to process Covid 19 claims and there are many unanswered questions that could cost your business and your plan more than it should unless you have a process for managing Payment Integrity.  What do we mean by Payment Integrity?  It’s quite simply a fiduciary control that allows you as the plan sponsor to make sure that hospital claims that are submitted for reimbursement are for reasonable and appropriate services.  You think you already have that now?  Think again as most contracts between insurance companies and hospital providers have limitations on what’s reviewed and also what needs to be submitted.  Consider that Jim and his company find errors in ALL claims they review, it’s safe to see that you as a fiduciary need to take precautions to assure your plan assets are only being used for fair and reasonable charges.  In 2018 there was an estimated $67 Billion Dollars in overpayments and that nearly all hospital claims have billing errors?  How much money is your healthplan overpaying for medical claims?  Medliminal has historically been able to recover $100,000 to $200,000 for every $1,000,000 in medical claims reviewed.

Jim’s background as a litigator in the healthcare space give him a unique perspective to lead his company.  Listen to this podcast and what keeps Jim up at night as he has to balance the urgency of reimbursement with the practicality of protecting plan assets for his clients.  You should be concerned too.

Medliminal Website:  https://medliminal.com/