ACCOUNTABLE CARE ORGANIZATION (ACO) STOP LOSS

Pinnacle Brokers is at the forefront of understanding new risk-bearing arrangements that are emerging in the healthcare marketplace, such as ACOs.  We are knowledgeable in servicing both Medicare ACOs and Commercial ACOs.

Benchmark Aggregate Stop-Loss Insurance is a newly developed product in response to the CMS ACO regulations.

  • Protects the provider from the overall performance of a given risk-based contract.

  • Applicable for Medicare ACOs accepting downside risk on either Track 1+, Track 2, Track 3, or Next Generation.

  • Benchmark coverage is offered from 2% to 15% above the CMS benchmark.

  • Policy limits of up to $20 million are available.

Pinnacle can also assist ACOs in securing a Surety Bond. For all ACOs taking downside risk, CMS is requiring them to provide a repayment mechanism to assure that shared losses can be repaid. Surety bonds are the recommended repayment mechanism over the other two choices, which are a letter of credit and funds held in escrow.

A few key points that make Pinnacle a unique broker are as follows:

  • Claim Auditing Services. We can audit 1 to 3 years of claims data for billing and payment errors, duplicates, and trends in the data.

  • Claim Filing Services. Clients have the ability to send Pinnacle a “data dump” of all of their paid claims for the policy year and Pinnacle will prepare the proper submission to the carrier.

  • Pre-Carrier Claims Adjudication

  • Underwriting Expertise

  • Deductible Analysis

  • Pended Claim Tracking

  • Quarterly Reports and Division of Financial Responsibility Matrix Review

  • Full Transparency

  • Strong Relationships with Most Major A+ Rated Stop-Loss Carriers