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.
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Protects the provider from the overall performance of a given risk-based contract.
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Applicable for Medicare ACOs accepting downside risk on either Track 1+, Track 2, Track 3, or Next Generation.
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Benchmark coverage is offered from 2% to 15% above the CMS benchmark.
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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:
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Claim Auditing Services. We can audit 1 to 3 years of claims data for billing and payment errors, duplicates, and trends in the data.
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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.
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Pre-Carrier Claims Adjudication
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Underwriting Expertise
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Deductible Analysis
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Pended Claim Tracking
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Quarterly Reports and Division of Financial Responsibility Matrix Review
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Full Transparency
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Strong Relationships with Most Major A+ Rated Stop-Loss Carriers