U.S. District Court of Appeals Finds BCBS Direct Payment to Patients Violates Assignment of Benefits Law
The Blue Cross Blue Shield practice of mailing direct payment of out of network benefits to patients instead of assignment-holding providers was recently found to be a violation of Louisiana law, a ruling which casts into question the legality of millions of dollars in benefit payments which BCBS has sent directly to patients. BCBS has…
Increase Pay-up by Successfully Appealing Claim Denials
What if every time you had a patient in v-fib, you were allowed to shock him only once? What would your success rate be? Everyone in EMS knows that defibrillation often works only on the second, or even the third, shock. The same principle holds true when it comes to getting reimbursed for medical transportation.…
Precertification ICD-10 Training Recommendations
How can your organization anticipate and prepare for Payer ICD-10 pre-certification performance interruptions? We recommend developing a ICD-10 training program for pre-certification staff focused on Payer Performance Monitoring. Yes, precertification staff need the traditional elements of basic ICD-10 role-based training, However, consider adding the following Payer Performance Monitoring initiatives to your precertification training session: Impact…
An Ounce of Appeal is Worth a Pound of Payment
The health care hue and cry grows louder everyday. Medical and mainstream publications are filled with stories focusing on the barriers doctors and hospitals face in getting paid in today’s health care environment. Precertification, managed care and tight timely filing deadlines are just some of the hurdles medical professionals must finesse when seeking reimbursement. And…
New Power of Appeals Reports
Are your organization’s financial vital signs hard to take? The increasing complexity of medical reimbursement means increasingly complex financial health analysis. Power of Appeals software is the leader in denial management with its powerful database of 1600 compliance-focused appeal letters. Now, Power of Appeals provides additional financial analysis tools to allow users to achieve better…
Quote From Favorite Book
If you ever find yourself tired of appealing denials and advocating for care, reading the book “Negotiating From An Uneven Table: Developing Moral Courage In Resolving Our Conflicts” may be the verbal elixir you need. Nurse and author Phyllis Beck Kriteck spells out how to maintain a moral backbone in the world of unevenly granted…
