Eric Bricker, MD

The Doctor or Hospital Tax ID Number is SUPER Important... Why?? Because the Tax ID Determines Payment... of course. 😉

The Tax ID Number is referred to in healthcare as the TIN... pronounced like 'tin' the metal.

Each physician's practice, hospital system, etc. has their own TIN. It is like the 'license plate' for the organization.

The TIN is listed on the claim sent to the insurance company. The insurance company then correlates the TIN with the appropriate contract for that practice, which then dictates reimbursement.

Private Equity firms and physician practices strategically use the TIN to increase reimbursement by 'rolling up' multiple physician practices into one company and then billing all the claims for all the practices with the TIN for the one practice that has the highest reimbursement rate.

Aetna has sued physician group Radiology Partners for allegedly using this approach in Florida.

Also, UHC has sued Radiology Partners for allegedly using this approach in Texas.

Whether or not the 'Roll Up' of physician practices under one high-paying TIN is a 'scam' or 'fair' is not the real issue.

The real issue is that these prices are hidden from the ultimate payer of the claims... Patients and Employers. Make the prices transparent and let the market decide.

Sources at AHealthcareZ YouTube Channel.

#Healthcare #HealthInsurance #EmployeeBenefits

Employer #ClaimsData: Who Owns It? Implications of the Consolidated Appropriations Act of 2021 and Lawsuits.

Self-funded employers generally have difficulty obtaining detailed claims data from their health insurance carrier (e.g. United, Blue Cross, Cigna, Aetna, etc.).

The self-funded employers pay the claims, but they do not have detailed information on what they are paying.

The Consolidated Appropriations Act of 2021 (CAA) changes the regulations related to this data roadblock for employers.

The CAA states that 'Gag Clauses' by health insurance networks that stop employers and plan members from seeing healthcare price and quality data are prohibited.

There have been multiple lawsuits related to data access as well. Connecticut Unions sued Elevance--the parent company of Anthem Blue Cross--for giving them access to claims data. This suit was dismissed by a judge in April 2024.

A plan member on the Johnson & Johnson health plan sued the company health plan for failure to monitor the cost of medications with data--along with other complaints.

As healthcare lawyer Chris Condeluci puts it, "The best approach [for employer health plans] is to continue to point to the new Gag Clause Prohibition as the means to accessing the plan's data. You [the employer health plan] must argue that by failing to share claims data with the plan, the owners of the provider networks are effectively forcing the plan sponsor to breach their ERISA fiduciary duties."

Sources at AHealthcareZ YouTube Channel.

#Healthcare #HealthInsurance #EmployeeBenefits #Data #DigitalHealth