It is an all too common occurrence: a motorist is seriously injured in a car accident and requires emergent treatment. According to the National Safety Council, nearly 6,300 people sustain serious injuries every day in the U.S. due to motor vehicle accidents1. Most of these people are immediately transported to the nearest hospital for care. Checking to see whether the doctor or hospital is “in-network” is a secondary concern. Everyone’s priority is saving the patient’s life and restoring function to the injured body.
Continue reading “How & Why We Negotiate Medical Claims” »
The Affordable Care Act (ACA), also known as “ObamaCare” is rapidly and profoundly changing the American healthcare landscape. In addition to expanding coverage to millions of people, the law imposes a new host of regulations and taxes on businesses.
Continue reading “Why TPAs and ASOs Need to Offer Claim Review Services” »
Nokomis Health recently reduced the cost of a $100,000 air ambulance claim by 76%. As a national leader in payment integrity and claim support services, Nokomis once again demonstrated a unique understanding of a very nuanced and expensive corner of healthcare services. Continue reading “Managing high-cost air-ambulance claims” »
Nokomis Health’s coding team was reviewing a client’s out of network laboratory and a batch of genetic testing claims raised some questions. The claims appeared to be legitimate – the CPT code was valid, the diagnosis code supported the charge, the NPI and TIN were correct – but the charges were very high for the code and it was unusual for the code to stand alone. We obtained records on several claims and found that the lab was simply performing a quality assurance function, they were not performing a covered service.
Continue reading “Schemes, Errors & Scams – How Uncommon Claim Review Findings Lead to Savings” »