Tag Archives: CIGNA
Big Insurers Underspend On Medical Care, Senate Probe Finds
Posted on 03. Nov, 2009 by Editor.
Which big health insurance company did lawmakers single out? Is it the one that gives you the most denials trouble?
A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care.
Insurance industry officials say that all health insurers spend an average of 87 cents of every dollar on medical care, reports The Wall Street Journal. For the trade-group-curious, America’s Health Insurance Plans (AHIP) came up with the ‘87 cents’ figure.
And I bet you can tell me the names of the insurers that ‘underspend’ without reading the rest of the article. But just for grins — they’re Aetna Inc., Cigna Corp., Coventry Health Care Inc., Humana Inc., Unitedhealth Group Inc. and Wellpoint Inc., reports the Journal. These big fish spend an average of 74 cents on every dollar individuals pay in premiums on medical care (if they’re on individual plans). That figure goes up a bit for small group (80 cents). However, even the large group insurance average (84 cents) for these six insurers doesn’t hit AHIP’s estimate of how much premium money goes to actual medical care.
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Make Even Problem Payers Pay Up With These Tips From 2 Pros
Posted on 10. Aug, 2009 by Editor.
Follow this 3-step path and get results from every payer.
At some point in her career, every biller deals with them. They are problem payers — and they can wreak havoc on your billing and on your practice’s income. Payment delays, improper denials, and claim rejection errors cause more work for you and can be a serious hurdle in getting the timely payment your physicians deserve.
Take heart. We’ve got some field-tested strategies two veteran physician billers have used to bring in the money for their physicians’ services.
Step 1: Research the Original Claim
Your first step when you discover that you have a problem with a payer is to do research. If you’re facing payment delays, find out why. If you’re receiving improper denials, look at the denial reasons the payer is giving you on your explanations of benefits (EOBs).
AUDIO EXTRA: How to tailor your appeal to the payer you’re working with.
“My first step is to ascertain and review the status of that claim. I try to gain the ‘what and why’ of the situation and then address the particular issue,” explains Cheryl Nash, director of operations and senior account rep at American Physician Financial Solutions in Colorado Springs.
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Pssssssst. Payer Report Cards Are Out
Posted on 05. Aug, 2009 by Editor.
If you know your payers’ strengths and weaknesses, you’re better equipped to fight denials and negotiate contracts that are in your best interest.
So check out the American Medical Association’s second annual National Health Insurer Report Card. The AMA has gathered data and rated large payers on criteria like payment timeliness, accuracy, claim edit sources and denials, according to an American Medical News article that summarizes trends in the report card.
Drawback: The AMA’s payer report card looks only at big, national insurers (Aetna, Anthem, Blue Cross and Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare and Medicare). To get the dirt on smaller or regional payers, check out this resource from Athenahealth.
To see the AMA’s payer report card, go here.
Are your payers ‘remedial’ at best? USE THE APPEALS PROCESS LIKE A PRO, with APPEALS QUEEN Barbara Cobuzzi.
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CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59
Posted on 07. May, 2009 by Editor.
You now have clear-cut policies to apply, including 1 on 96110 pay.
Say goodbye to secret black box bundles and hello to transparent CCI edits for one more insurer.
Adhere to CCI Edits, CMS Modifier Guidelines
Effective April 20, “CIGNA will apply CMS National Correct Coding Initiative (NCCI) Incidental and Mutually Exclusive edits,” according to the payer’s March 2009 Network News. The change puts the insurer’s policy on a level playing field.
For years, CIGNA did their own thing, points out Patti DiSpazio, CPC, business manager at Island Coast Pediatrics in Fort Myers, Fla. “Following UHC’s change, they’re using CCI edits as a barometer.”
In addition, the payer will adopt many CMS modifier guidelines. “Modifier policies being updated are Modifiers 21, 22, 25, 59, 80, 81, 82 and AS,” CIGNA says.
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New Tool Can Help You Slash A/R for Cigna Patients
Posted on 06. Mar, 2009 by Editor.
In April, Cigna will launch its new ‘Cost of Care Estimator’ nationwide, reports American Medical News.
How it works: When the patient comes in, a biller enters CPT codes associated with the plan of care. The tool breaks down what Cigna will pay, and then estimates the patient’s portion.
Cigna tested the tool at 13 hospitals and with 250 physicians, AMNews reports. Pilot phase participants report that, without the tool, they underestimate what the patient will owe and are left with the task of collecting the difference later … More …
WEBINAR: Telephone Triage Tips for the Front Office, with Jill Young.
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AMA Sues Aetna, Cigna for Out-of-Network Reimbursement Rates
Posted on 23. Feb, 2009 by Editor.
The American Medical Association isn’t stopping with the $350 million United Healthcare settlement. Now, a class action suit involving the AMA has set its sights on Aetna and Cigna.
Still at issue: The fact that United Healthcare owns Ingenix, the supposedly ‘independent’ research outfit that has supplied UNH, Aetna & Cigna with reimbursement rates. The providers in the suit allege a conflict of interest … To read the AMA’s press release and the court complaints, go here …
FACT: Last year, family & internal medicine practices lost out on $9 million of their rightful reimbursement. Get the strategies YOU need to appeal.
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NY AG Fines United Health $50 Million for Under-Reimbursement
Posted on 15. Jan, 2009 by Editor.
Getting money from big insurers may be like squeezing blood from a stone, but New York Attorney General Andrew Cuomo is trying, says NBC’s Today Show.
Cuomo’s Beef: Oxford Insurance and its parent company, United Health Group, say they use an “independent research from across the health care industry” to determine reimbursement rates. Cuomo contends Oxford unfairly relies on a research firm United Health actually owns: Ingenix.
Other major insurers that use Ingenix include Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield … More …
Rhonda Buckholtz teaches you to go mano-a-mano with big payers at contract negotiation time.
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