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Is Your Fee Schedule Defensible?

    As a healthcare provider, are you able to defend your fee schedule to both patients and insurance carriers? A 2009 settlement in a lawsuit filed by New York’s Attorney General against United Health Group has resulted in the formation of an independent nonprofit entity named FAIR HealthTM.   FAIR Health was called upon to […]

Texas Department of Insurance Imposes Fines on Payers, Doctors, Clinics

The Texas Department of Insurance, Workers’ Compensation Division (TDI-DWC) has just released a list of payers, clinics, and doctors for whom disciplinary measures have been imposed due to violations of the Texas Labor Code and DWC rules. A brief review of the Enforcement Actions posted for 2011 reveals that roughly half of the entities who […]

November is Heal that Claim Month

Do you wish you and your staff had more time and resources to focus on caring for your patients?  November is the third annual “Heal that Claim”TM month, and physician practices are being urged to take a stand against flawed and inefficient claims processing. One in five medical claims is processed inaccurately by commercial health […]

Alert: Idaho Medicaid to Hold Payments!

Healthcare providers in Idaho and billing companies serving Idaho providers who accept Medicaid patients should be aware that a payment hold has been scheduled  for the last 3 payment cycles of the fiscal year, which ends June 30, 2010.  Hospitals and nursing homes will experience an extended hold time of 8 to 12 weeks. While […]

Talking with Patients about Out-of-Pocket Expenses in 2010

The new year is almost nigh and we can expect patient out of pocket costs to go sky high! While it seems that every new year brings higher patient deductibles and coinsurance and reduced benefits, I have definitely seen the trend escalating over the past few years. 2010 portends to be no exception to that […]

Texas Dep’t of Insurance Workers Comp Division Releases 2009 Report Card

The Texas Dep’t of Insurance Dep’t of Workers Compensation has recently released the results of its 2009 Performance-Based Oversight Assessment. The results of the assessment could impact your practice. Assessments were conducted on the performance of two key players in the worker’s compensation arena:  insurance carriers and healthcare providers. Insurance carrier report card Insurers were […]

Texas Worker’s Compensation and Preauthorization Rules

There seems to be confusion among healthcare providers and their staff regarding which services must be preauthorized under Texas Worker’s Compensation rules, what is required of the provider, and what are the obligations of the carrier. A number of treatments and services do require preauthorization, below are just a few: Inpatient hospital admissions Surgical procedures […]

Legible Documentation Signatures—Not Optional

A recent alert went out from various Medicare contractors concerning the requirement for  healthcare providers to include a legible signature on their documentation. It turns out that in some cases, providers are not signing their documentation at all! Audits conducted by the Office of the Inspector General (OIG) and CERT (Comprehensive Error Rate Testing) have […]

Billing a Non-covered Service under a Payable Code

Can we do that? I could not begin to recount all the times I have heard healthcare providers or their staff ask if they can bill Medicare or another insurance carrier for a non-covered service that they perform, but just code it as something else so that they can get paid. It is little wonder […]


I am so excited to be starting my blog and get it up and running!  I have a long way to go but this is a start right? As a certified medical reimbursement specialist, it is important for me to stay current with what is happening in the healthcare industry and to share that information […]