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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Medical Coding 101 – Insights, Challenges and Standard Practices

Nokomis Health | Medical Coding 101


What are CPT Codes?
As you may know, every procedure code on a claim is tied into a dollar amount. So if a coder miscodes something, the provider could be paid for a code that isn’t supported by the documentation or the clinic may be losing reimbursement that is rightly due to them. Miscoding is typically a result of coders lacking education and not knowing how to code properly or they may be trying to game the system. That’s why insurance companies need a claim review partner. We can look for trends that we see in the claims and set an edit to manually review those claims or automatically deny them. Just because there is a CPT code doesn’t mean that you can use that code for reimbursement or use it for reimbursement in combination with other codes.

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How Do You Become an Expert Medical Coder?

Nokomis Health | Director of Coding Anne Karl


How did you get into coding?
My father was a family practice physician and I’ve always been drawn to that world. When I came out of school the traditional job for an RHIA (Registered Health Information Administrator) was to be the Director of Medical Records in a hospital setting, but that didn’t really interest me. The physician setting is much more fast-paced and I’ve spent a majority of my career in that area. I always had my heart in it – making sure the providers were paid fairly for their services. Payment starts with the documentation of the provider and the codes assigned. Poor documentation and/or coding can really hurt the reimbursement to a provider. After working in some very non-traditional jobs, I found that coding was really my passion.

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