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Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs - Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs EPISODE 36, 24th September 2018
Merrit Quarum, M.D. | WellRithms Inc.
00:00:00 00:42:29

Merrit Quarum, M.D. | WellRithms Inc.

Topics:

  • Hospital Billing Errors
  • Medical Bill Review
  • Reference-based pricing
  • Price Transparency
  • Network Discount Model
  • Chargemaster
  • Balance Billing
  • Cost Savings

In this episode, Michael introduces you to Dr. Merrit Quarum,  Founder and CEO of WellRithms Inc. Join us as we discuss how WellRithms endeavors to transform healthcare through Hospital medical bill review and transparent and economically sustainable reimbursement practices.

Here’s a glance at what we discuss in this episode:

  • Dr. Quarum’s diverse health care experience and why he founded WellRithms
  • What is wrong with our healthcare delivery system as it pertains to affordability, reimbursement, and lack of price transparency
  • How WellRithms provides an integrated facility medical bill review and establishes a reasonable reimbursement amount for medical services
  • Why detailed facility medical bill reviews may not be happening with traditional TPA’s and networks and they may not be protecting an employer from unreasonable charges
  • Examples of Hospital medical bill errors and why auditing is so valuable
  • The prevalence of Hospital medical bill errors
  • The average amount of cost savings WellRithms medical bill review yields clients
  • The difference between reference-based pricing compared to traditional network reimbursement pricing
  • Why reference-based pricing based on Medicare multiples may pose a problem if the facility or hospital challenges the reimbursement  
  • WellRithms reference-based pricing methodology compared to traditional reference-based pricing and why WellRithms methodology is legally defensible, backed by case-law
  • How the WellRithms methodology of pricing is fully indemnifiable and the employer and employee is protected when a Facility challenges the reimbursement level
  • The types of savings an employer can achieve relative to the Network Discount Model
  • Myths about balance billing with reference-based pricing and how egregious balance billing scenarios frequently happen in a network discount model
  • How a self-insured program with WellRithms reimbursement structure compares to capitation models
  • WellRithms unique cost structure and who they are a good fit for
  • WellRithms website and contact information: http://wellrithms.com/