BRMS Cost Containment

Cost Containment

BRMS’ Cost Containment Program was designed to help improve your plans performance and effectiveness, reducing your overall healthcare costs.

Risk Assessment & Insurance Underwriting

Self-Funded Coverage

Stop Loss Coverage Placement

Self-Funded Coverage

BRMS can help you determine whether and how to self-fund your company’s employee benefit program.

We have the expertise to educate you on the advantages and risks of self-funding and how to protect those risks with stop-loss insurance programs. We will walk you through a step-by-step plan to explore whether this alternative funding solution is a good fit for your company.

In implementing a self-funded benefit program, we employ seasoned industry veterans to design an optimal benefit plan for each organization and benefit group.

You also receive extensive reporting with our inclusive data warehouse, to review and analyze claims activity for better decision making. When losses occur due to unforeseen situations, we aggressively take action to control the loss with a fully-staffed utilization review and medical management teams.

Stop Loss Coverage Placement

With a highly experienced team, and leading healthcare partners, we provide expert advice to employers of all sizes nationwide on the selection and purchase of stop loss insurance and employee benefit packages.

Our sales and marketing team evaluates your risk for a determination of plan specific and/or aggregate reinsurance, clarifying the level of underwriting and placement necessary to protect you against unpredictable losses.

BRMS is approved by all major direct and MGU Reinsurance markets. We work with actuarial partners and reinsurance underwriters to ensure a comprehensive analysis of your healthcare risk.

Denials and Appeals

BRMS has extensive experience with all stages of the governmental payer appeals process and has achieved unmatched success in identifying and obtaining the reversal of thousands of inappropriate medical necessity denials at all levels of appeal. BRMS’s methodology combines expert physician clinical expertise, focused on medical necessity; with regulatory arguments so all appeal avenues are explored.

Medical Management/Utilization Review

Medical Management

Utilization Review

Medical Management

We have a unique approach to medical management. We begin by building a partnership with our clientele, thoroughly analyzing and understanding the unique challenges they face. We then apply cutting-edge cost containment methods, reducing costs while maintaining a quality employee benefits program.

We provide comprehensive medical management services through a professional staff of physicians and nurses who are highly qualified in cost management issues including quality assurance standards.

Our firm continues to grow and prosper due to:

Comprehensive Case Management
Medical Director Review
Disease Management
Transplant Contract Negotiation

Monitoring of all Physical Therapy, Speech Therapy and Occupational Therapy
Pre-Authorization
Pre-Admission Review
Concurrent Review

Utilization Review

To ensure you are optimizing your benefits plan, BRMS’ Utilization Review program combines the expertise of registered nurse reviewers, our board certified Medical Director, and practicing physicians to help direct patients and providers toward the most cost-effective, quality-driven treatment available.

The clinical professionals providing BRMS’ Utilization Review services use established national medical guidelines to evaluate the medical necessity for hospitalizations, outpatient services and appropriateness of overall treatment plans.

Our Utilization Review program emphasizes systems that provide control of, and accountability for, utilization of services. Identification may include over – or under-utilization of services and inappropriate utilization of services in terms of medical necessity and level of care.

When first diagnosed with cancer, my diagnostic MRI was not authorized in time and my appointment was canceled. The stress and anxiety brought on by a cancer diagnosis is enormous, especially while waiting to hear what stage your cancer is and where else it may be in your body. I could not think straight, let alone do my job as a third grade teacher, while unanswered questions filled my head. I reached out to my school district insurance liaison and was matched with Mr. Matthew Todd at BRMS. It was the first time I had exhaled in the days following my diagnosis. Mr. Todd assured me he would get all necessary authorizations completed. As promised, I was approved for the breast MRI that day. From that day on, Mr. Todd and Sara have been the most efficient, pro-active advocates I could ever wish for. They have both gone above and beyond to ensure that I receive the care I need to return to my classroom healthy and strong. They have reduced my stress immensely and made this cancer journey so much easier for me and my family. My surgeon’s office manager told us that Matthew and Sara were the most professional insurance care case managers that they have “ever worked with.” This month marks one year from my diagnosis and I am back in the classroom, thanks in large part to Matthew and Sara. They have been a true blessing!

Plan Member

Los Alamitos USD

Our case manager Eric is fabulous! He always go above and beyond to help me navigate the health care system. Having two daughters with Autism any extra help is appreciated. He helps me when I need it, so be how to find a specific specialist or walking me though claims & EOB’s. He is a godsend to this family. We would be lost with out him.

Stacey Anderson

Graniterock

Sara did a phenomenal job today helping me. She responded quickly and professionally to the email I sent describing the issue. She made a phone call to my doctor’s office, she is also coordinating a letter of agreement that will allow me to continue working with my established doctor for on-going medical issues. I am extremely appreciative of her knowledge and support. Thank you!!

Sandy Campos

Sunrise Medical

Transition of Care

BRMS Transition of Care Benefits may be available to your employees and their dependents as a member of a new plan joining during open enrollment. Transition of care allows patients with certain medical conditions to continue their treatment with non-participating providers, at the network level of benefits, for a specified period of time.

Out of Network Savings Program

BRMS Out-of-Network Savings Program identifies non-par claims incurred by your health plan and identifies the lowest cost outcome for you and your members.

Negotiation Process

Bill Review & Audit

Established Reimbursement Schedule (ERS)

Negotiation Process

The negotiation process incorporates a comprehensive line-by-line review of the charges, along with skilled medical negotiators reviewing appropriateness of services rendered. The team then aggressively negotiates with non-network hospitals, physicians and ancillary healthcare providers to help reduce our clients’ and their employees’ healthcare expenses. Our medical review negotiation team is supported in the negotiation process by a variety of cost databases, claims utilization history databases and reference tools to substantiate their negotiations.

Bill Review & Audit

Our Bill Review and Audit service is comprised of a team of healthcare professionals who perform chart audits on high dollar medical claims in order to uncover errors and anomalies to determine the appropriateness of billing. We utilize clinical, financial and medical necessity reviews to produce the highest level of cost reduction for our clients.

Established Reimbursement Schedule (ERS)

The Established Reimbursement Schedule (ERS) was developed to calculate a reasonable and acceptable reimbursement for all medical procedures. The process uses multiple data points to calculate savings and is far more comprehensive than most solutions can offer. We use:

Cost-to-charge ratios
Historically acceptable reimbursements
Geographic adjustments
Commercially available benchmarks

PPO contractual reimbursements
Medicare reimbursements
CMS-provided statistics

Wellness Solutions

BRMS’ wellness philosophy is that healthy employees lower the risk an employer takes on in self-insuring. Our below partners are great resources for you and your employees:

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Call us NOW to let us help create a custom Cost Containment Program that best suits your businesses needs.