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” »
Industry conferences generally illuminate growing trends and broad, often brilliant ideas. Distinguished presenters glide through slides and issues providing probable causes and ideal answers. One can almost feel the enthusiasm ricocheting off the walls of Ballroom A… We’re going to make it after all!
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).
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.
INTERVIEW WITH FOUNDER RICH HENRIKSEN
How did you get started in the claims field? What was your career path prior to Nokomis Health?
I graduated from Luther College in Decorah, Iowa with a biology degree and then received my master’s degree in hospital administration from The University of Iowa. Scott Anderson, the CEO of North Memorial Medical Center in Robbinsdale, Minnesota, was an alumnus of my graduate program and each year he took on an administrative fellow from my program. He selected me to come to his hospital, so I moved to Minneapolis and ended up staying at North Memorial for 7 years. I was originally deployed to the Finance department, where I automated the hospital’s budget process. I stayed in Finance for my entire tenure at North, ultimately becoming the director of managed care. It was at this time that I really learned about coding, reimbursement, contracting, contract modeling, and data analysis. Pat Boran, the CFO, was a super boss and mentor. I learned a great deal from him.
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.