Our Services

As differing lines of insurance require different areas of expertise, Austin Resolutions staffs teams of financial professionals dedicated to focused performance in Health, Workers Compensation, Auto, Catastrophic Care, Medicare Exhaustion, Marine (Jones Act and US L&H), and Transplant care.

In addition to medical claims negotiations, Austin Resolutions also offers consulting services focusing on specialty, or "hybrid" network development. Our consulting services are available to assist self-funded groups desiring to develop their own provider network offerings and covers access standards development, provider screening and credentialing, contracting, ongoing network maintenance and growth, and performance reporting.

Our Performance

Austin Resolutions fully believes that our success begins with our people and our approach. Austin Resolutions is made up of financial and health care professionals, including former hospital administrators, accountants, and financiers. Our approach differs from other cost containment firms in that our approach is purely financial, not clinical. Rather than beginning negotiations based on a clinical reduction platform wherein you are across the table from clinical experts, we choose to focus where our expertise lies.

Approaching cost containment and loss limitation from a perspective of understanding the overall financial impact of an episode of care has yielded historical exposure reductions of 39%, independent of the type of insurance involved. On average, we are successful in negotiating 68% of the dollars that flow through our company, again, independent of the type of insurance involved.

Not to be overlooked in our performance is our reputation. Austin Resolutions will always work on behalf of our clients with the utmost integrity. We are very much aware that as we represent our clients financially, we are branding the products they sell. A large part of any negotiation service should be the firm's focus on relationships. Austin Resolutions believes very strongly in doing good business. In our industry this means dealing fairly and honestly with the medical providers we negotiate with. It serves little purpose to work with a provider in such a manner that the provider will be encouraged to turn insureds away in the future. On both sides of the fence, payer and provider, there is an idea of a fair payment. Let Austin Resolutions find it for you.

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Our Process

Case CONSULTATION

Getting started with Austin Resolutions is easy. Simply call 800-844-7090 from 8:00am to 4:30pm, central time, to schedule a consultation.

Program GOALS

During the consultation an Austin Resolutions representative will discuss your program goals, and how we may be able to enhance any existing cost containment programs you may have in place.

Desired Dollar THRESHOLD

Once the consultation is completed, simply outline your desired bill transfer process (paper or EDI) and the dollar threshold you would like. Once a bill is received, Austin Resolutions will provide a written notice of receipt. After completing negotiations, a re-pricing statement will be forwarded back to the client representative along with a date payment is to be received. We can either return the signed provider contract to your representative or electronically archive the contract in-house.

Now you have a CHOICE!

Staffed by Financial and

Health Care professionals.

Leading Reputation of Integrity.

The Market

To say that the current state of American health care is in flux would be a gross understatement. As the cost of care continues to rise, the market is beginning to question the overall loss of value associated with current cost containment offerings. No longer is it enough for a payer to utilize a PPO; the discounts from billed charges can be misleading to say the least. Consider, for example, the contracting route that many of the big-box PPO networks take: Per-diem reimbursement with a variable stop-loss threshold, or a flat "percent off" reimbursement methodology. In either scenario, are costs really contained? 

In evaluating a fair payment level for any given medical service, one must question if the options available are the only ones in existence. The per-diem / stop-loss contracting methodology is, in essence, a revenue split between the PPO and the health system. The networks secure seemingly advantageous per-diem rates for their clients, but in return the health system insists on a lower stop-loss threshold. The financial incentive then exists for the hospital to ensure that the stop-loss threshold is met, thereby reverting to a percent-off methodology and voiding any savings achieved through a per-diem reimbursement model. In a flat percent off of billed charges contract, payers need to ask if the discounts are keeping pace with annual hospital charge inflation. In order to remain effective, a contract of this nature needs to be written in such a way that the "percentage off" increases over time just to break-even with hospital charge increases. The reality is that the 20% reduction the network boasts of was only a true 20% reduction for the time period that the contract was made effective. In fact, the contract has been decreasing in overall value with every annual charge master increase from the health system. 

Increasingly payers are realizing that it is their clients who foot the bill for what has become a very synergistic financial relationship between many networks and the hospitals they choose to do business with. It is for this reason that many payer groups are looking to service firms such as Austin Resolutions to provide cost containment in a manner that achieves significant and sustainable value to those actually paying the bills.