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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Building a Better Claim Review Company

Nokomis Health | Founder Rich Henriksen

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.

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