CCC Medicare Benchmarking: Helping Insurers Determine Appropriate Costs When Evaluating Submitted Medical Bills
Medical billing amounts have exponentially increased in recent years. Inflation often seems untethered to reality, with unpredictable billing variations, even for the same procedures at the same locations. The coronavirus pandemic shined new light on these pricing fluctuations, with reports showing a total billing variation of 2,700 percent for diagnostic testing.
There is also a large discrepancy between what facilities and providers bill for services compared to what they accept as payment in practice. When evaluating negotiated prices against Medicare reimbursement rates for the same procedures and facilities, a 2019 RAND Corporation research report found relative pricing variations ranging from 150 to 400-plus percent of Medicare rates.
To help insurance adjusters make consistent settlement recommendations, CCC has added Medicare-indexed benchmarking to its third-party casualty solution.
How CCC Medicare Benchmarking Works
CCC enables billing configuration flexibility at the state level. Insurers can select either Medicare, FAIR Health or Fee Schedule (where available) as a benchmark.
Insurers can apply benchmark configurations and Medicare multipliers on a per-state basis. Adjusters can also modify Medicare multipliers on one or more lines to easily adjust considered amounts. CCC provides further configuration by bill type — facility vs. non-facility.
In addition to the multiple configurations set by the carrier, adjusters can modify multipliers to meet the unique characteristics of each individual claim, giving them the flexibility they need to apply discretion when evaluating the costs considered as part of the submitted medical billing.
CCC Medicare Benchmarking Benefits
CCC’s Third-Party Casualty solution provides several unique Medicare Benchmarking benefits to help deliver a better claims experience:
1 – Flexible Configurations
CCC enables comprehensive, package-level medical bill review, including state-level configurability by multiplier, provider type (i.e., inpatient, outpatient, individual provider) and more. This provides a greater range of options for adjusters beyond purely on/off configurations across U.S. regions.
2 – Improved Consistency
CCC provides an extensive range of options for Medicare Benchmarking. With multiplier configurations applied on a per-state basis, adjusters can more consistently evaluate casualty claim medical specials.
3 – Clear methodology
Insurance adjusters benefit from a clear methodology to enable more effective review of the considered medical specials with providers, attorneys and claimants. Medicare Benchmarking leverages a nationally available price benchmark that is familiar to medical providers and others involved in the claims process. Adjusters can point to the specific multiplier used to calculate an adjustment, making it easier to explain recommended amounts.
4 – Adjuster Modifications
With CCC’s Medicare Benchmarking, the insurance carrier selects their desired Medicare configurations. The adjuster remains in the driver’s seat when using or modifying the recommendations, with the ability to efficiently adjust bill lines for a particular claim.
Medicare Benchmarking is delivered through CCC’s third-party casualty claims solution, which provides consistent and efficient package-level treatment of injury claims, as well as business analytics and what-if modeling.
Visit CCC’s Third-Party Casualty page to learn more.