Chemical Dependency
The problem: Runaway costs, treatment centers & labs
The solution: 71% reduction in cost
Affordable Care Act Information…
Mental Health Parity requirement of the Affordable Care Act gave rise to resort-type addiction treatment centers
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- Exorbitant daily fees
- Lab and counseling fees unbundled
No Surprises Act Information…
NSA effect on Chemical Dependency and Labs
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- Not directly effected
- Typically non-emergency situations
- Out of network facilities
- Out of network providers bill market prices for services.
- NSA does not restrict billing for non emergency out of network chemical dependency and lab claims.
- Not directly effected
Increased Substance Abuse and Mental Health Claims Since COVID-19
- 18% increase nationwide in overdoses compared with same months in 2019.
- Trend continued throughout 2021
- Substance Use Disorder cases have risen threefold since before the pandemic
The solution: PNA's Negotiation Services Program
Product Methodology – PNA methodology in the negotiation process with providers allows us to conduct the negotiation based upon details specific to the claim in question. This unique skill set can be generally defined as a 4‑step application.
- Step 1 - Benchmarking Medicare allowable to billed charges by revenue code and developing a cost to billed charge ratio.
- Step 2 - Engage in provider negotiations based upon audit findings.
- Step 3 - Reaching provider sign off through written agreement substantiating all aspects of the negotiation thereby eliminating balance billing and discount reversal. The methodology does not vary.
- Step 4 - Provider contractually agrees to the negotiated discount.
