By Erik Fuglestad, Senior Director of Product Solutions, Zelis
Zelis Healthcare has added a valuable program for payers frustrated with the escalation of commercial dialysis prices and the impact that’s having on group health plans. Currently, 15% of U.S. adults have chronic kidney disease, and along with increased incidence of dialysis, patients are living longer on treatment adding to the overall costs. Due to these factors, dialysis claims have become a key concern for payers.
The first question many would ask is why are commercial dialysis prices so high? The simple answer is that 80% of patients on dialysis have Medicare as their primary payer and Medicare has fixed bundled composite rate pricing that only changes once per year, and it doesn’t always increase. This could lead to providers’ billing practices being altered to capture increased commercial revenue share.
In addition to the patient mix, the dialysis market is dominated by large providers that make up 80% of the facilities in the country. These providers have done a great job bringing dialysis treatment to underserved areas; however, their market saturation has limited potential treatment options for numerous patients and payers.
Realizing the financial burden that dialysis is putting on our clients, Zelis has developed a dialysis program that can effectively identify and manage claims before, during and after treatment has begun by utilizing multiple methods to secure the deepest savings for all claim scenarios. Key benefits of this program include:
- Proactive – Program is put in place before it’s needed
- Flexible – Clients choose the re-pricing option that best fits their cost management strategy
- Maximized Savings –Up to 90% off billed charges
- Defensible – Full appeal support
Zelis can help all payer types looking to mitigate risk and successfully combat dialysis costs, with different payment options for both in and out-of-network providers, thus enabling payers to fulfill their fiduciary responsibility.