Itasca, IL (March 12, 2019) - Discovery Health Partners today announce that since the launch of its ESRD Premium Restoration solution in late 2018, more than 20 health plans ranging from large national to small regional plans have signed on for the new solution. To date, Discovery Health Partners has helped identify and restore millions in underpaid premiums for these customers.
Discovery’s ESRD Premium Restoration solution helps Medicare Advantage (MA) plans restore underpaid premiums from Centers for Medicare and Medicaid Services (CMS) for members with ESRD. ESRD, end-stage renal disease, is the final stage of chronic kidney disease and requires patients to undergo dialysis or a kidney transplant to survive. These treatments are expensive and require life-long care. CMS pays MA plans a significantly higher premium for each member with ESRD to help cover the higher costs of treatment. But for various reasons, CMS sometimes does not accurately identify members with ESRD. When this happens, MA plans don’t receive the higher premiums from CMS and, therefore, operate at a deficit for these members.
“MA plans are challenged with efficiently managing members with ESRD, navigating CMS processes, and working with service providers to optimize financial outcomes,” said Kevin McDonald, Vice President of Eligibility Operations at Discovery Health Partners. “Discovery is adept at navigating these complex processes, and this expertise fills a real need for clients. We are pleased to support large and small health plans through this complex process of restoring underpaid premiums and ensuring accurate premiums are received going forward.”
Discovery Health Partners’ ESRD Premium Restoration solution adds to its suite of solutions that help health payers improve revenue, avoid costs, and enhance the member experience.
About Discovery Health Partners
Discovery Health Partners’ mission is to deliver unique, actionable analytic insights and technology-powered solutions to help healthcare payers improve payment integrity, increase revenue optimization, and maximize efficiencies with government programs. Serving more than 60 health plans across the U.S., including six of the 10 largest U.S. health plans, Discovery has been recognized consistently for its growth—earning a spot on the Inc. 5000 list five years in a row and the Crain’s Fast 50 three times. For more information on Discovery Health Partners, go to http://www.DiscoveryHealthPartners.com.