bhoffman | August 16, 2010
By Deborah J. Williamson of Warner Norcross & Judd LLP, www.wnj.com
A frequent question of physicians, medical practices and other providers I represent is whether the HIPAA Privacy Rule prohibits them from providing third-party payors with access to medical records for the purposes of an audit. In other words, does HIPAA prevent third-party payors from conducting [...]
Adam V. Russo | July 23, 2010
By Steve Rasnick
I really don’t mean to pick on TPA’s because the same statement could be made for all businesses and business relationships, including insurance agents. In fact, I began to think of this issue as I focused on the fact that on 2/1/10 my TPA celebrated its 13th year of business in Southwest Florida. [...]
Adam V. Russo | May 24, 2010
MyHealthGuide Source: Fred Hunt, President, Society of Professional Benefit Administrators (SPBA), 5/21/2010, www.SPBATPA.org
Background
I have been giving these industry and market report/forecasts for 30 years. Most have predicted things that seemed unbelievable at the time. However, the accuracy rate of coming true has been over 90%. This is being written when the shock of the Obama [...]
Adam V. Russo | April 27, 2010
In Hartsfield, Titus & Donnelly LLC v. Loomis Co., (DC NJ 2010), the employer (“Hartsfield”) sued an insurance agency (“Loomis”) that had administered its employee medical benefits plan because the TPA had made payments in excess of the minimum allowed under the Plan in three instances –two infertility claims and one substance abuse claim in [...]
Adam V. Russo | March 31, 2010
Roberto Ceniceros
Most self-insured employers have their third-party administrator manage their Medicare reporting and compliance requirements, but others have turned to independents, several sources say.
The independent companies specialize in Medicare Secondary Payer compliance and reporting requirements under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007.
Adam V. Russo | March 23, 2010
From The Bench By John H. Eggertsen, Esq. and Michael Friedman, Esq.
As health care costs continue to rise, and employers become more vigilant about policing benefit costs, it is perhaps inevitable that lawsuits by employers against their plan’s TPA are likely to increase. A recent such case, W.E. Aubuchon Company, inc. v. BeneFirst, LLC, 2009 [...]
Adam V. Russo | March 22, 2010
A common disclaimer used by third-party administrators (TPAs) to avoid fiduciary status was rejected by a federal district court, saying it was void as a matter of law.
The ruling by the U.S. Court for the District of New Jersey left the TPA vulnerable to claims for reimbursement to an ERISA health benefit plan for claims [...]
Adam V. Russo | March 15, 2010
March 09, 2010 — Particularly in the small-plan market, retirement plan providers are seeing more business come through third-party administrators (TPAs)—and, as a result, are ramping up their efforts to attract TPAs. —
A handful of providers have announced new initiatives, including financial incentives and new technology, to attract TPAs. For instance, The Guardian Insurance & [...]
Adam V. Russo | September 18, 2009
by Roy Harmon, III, www.healthplanlaw.com
A typical plan will contain an exclusion for accidents or injuries resulting from intoxication, unlawful conduct and so forth. How the plan states the exclusion can vary quite a bit, and the distinctions can make a significant difference in outcomes.
Adam V. Russo | August 11, 2009
Experts say employers’ efforts to stretch available dollars are keeping TPAs on their toes.
by Karen Pallarito, Workforce Management Online, www.workforce.com
The nation’s sour economy has added a new step to the tango of self-insured employers and third-party administrators handling their medical claims.
Adam V. Russo | August 5, 2009
Reaction from AMA, TMA, GMA, Self-Funded Employer• Getahn Ward, The Tennessean, 5/16/09, Tennessee HRI Article
• Emily Berry, American Medical News, 4/13/09, AMedNews Article
• Tennessee Medical Association (TMA) Legal Department 5/5/09, TMA Alert on HRI Recoupment Letters
Franklin (TN)-based Health Research Insights, has temporarily halted efforts to collect on potential overpayments of medical claims by two Nashville-area [...]
Adam V. Russo | May 29, 2009
by Karen Pallarito of Business Insurance, www.businessinsurance.com
The nation’s sour economy has added a new step to the tango of self-insured employers and third-party administrators handling their medical claims.
Employers still want a partner that provides first-rate claims administration and customer service, and many require TPAs to provide sophisticated data-mining tools and care management programs. Experts [...]
Adam V. Russo | May 29, 2009
by Karen Pallarito of Business Insurance, www.businessinsurance.com
Here are a few tried-and-true strategies to trim health care-related expenses without slashing benefits or shifting costs, experts say:
Compare reinsurance companies. Make sure your third-party administrator is working with well-regarded reinsurance providers, because spending on stop-loss coverage can run between 8% and 15% of total costs, said Helmut [...]
Adam V. Russo | April 13, 2009
by Emily Berry of AMNews staff, http://www.ama-assn.org/amednews/
When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter — vaguely threatening, insistent on a quick response, with few details.
The letter, addressed “Dear Health Care Professional,” accused Dr. Fine of [...]
Adam V. Russo | March 23, 2009
by Dave Lenckus of Business Insurance
While third-party administrators can deliver efficiencies for self-insured programs, risk managers should require protections and maintain vigilant oversight for instances when the claims process breaks down, risks managers say.
If “properly vetted,” a TPA can provide great service and “enhance metrics and decision making” said Wayne L. Salen, director of risk [...]
