It is estimated that medical fraud and abuse accounts for $80 billion worth of healthcare costs in the US. This rampant abuse of our healthcare system is detrimental to the system as a whole and contributes to higher healthcare costs and increased costs for coverage. With an incredibly complex medical billing system such as ours, medical providers and organizations are bound to make occasional mistakes when coding the services provided to patients. It is this same complexity which also makes fraud and abuse easier to commit and more difficult to detect.
As the healthcare landscape transitions, self-funded employers and insurers are reassessing their health plan designs to better cope with costs and impending changes. An estimated 2,000 large employers plan to migrate from more traditional plans to health plan designs that will prepare them for Affordable Care Act requirements and attempt to keep their premium contributions stable.
PayerFusion is a Health Plan Administrator and Cost Containment company offering comprehensive solutions for self-funded employers and international payers. Our health plan administration solutions are customized to meet the needs of our clients and include provider network design/support, policy design, full-service TPA, technology solutions/support and informatics. Contact us for more information and to learn more about our health plan administration services.