One Way to Prepare for the Cadillac Tax – Comprehensive Claim Review

Nokomis Health | Cadillac Tax

The Self-Insured Institute of America, or SIIA, is known for sponsoring great educational conferences, and the most recent Taft-Hartley session in Chicago was no exception. Many of the day’s speakers talked about how the Affordable Care Act, or ACA, is changing the healthcare landscape, sometimes for better, sometimes for worse. One particular area of concern that speakers and panelists discussed was the so-called Cadillac tax, which purportedly is intended to discourage overly rich benefit plans by imposing a 40 percent excise tax on any amount over the threshold (presently set at $10,200 for individuals and $27,500 for families, starting in 2020).

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Schemes, Errors & Scams – How Uncommon Claim Review Findings Lead to Savings

Nokomis Health | Stories from the Front Line

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.

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How & Why We Negotiate Medical Claims

Nokomis Health | Claim Negotiations

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.

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