Payer Update: UHC Sticks With Consult Codes

Posted on 12. Jan, 2010 by Editor.

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Check with Medicaid plans, insurer warns.

You can breathe a sigh of relief — one major payer will stick with 99241-99255.

UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC…

Big Insurers Underspend On Medical Care, Senate Probe Finds

Posted on 03. Nov, 2009 by Editor.

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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…

A Coder’s Guide to Health Care Reform

Posted on 24. Aug, 2009 by Editor.

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Quick way to show your practice you’re prepared for the unknowns ahead.

If anyone should be able to understand the complicated health care reform debate raging in Washington, it should be us coders and billers, right? After all, we’re closest…

Pssssssst. Payer Report Cards Are Out

Posted on 05. Aug, 2009 by Editor.

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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…

Tool: How Do Your Payers Measure Up?

Posted on 12. Jun, 2009 by Editor.

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Coders & Billers: Can you feel your life getting a little easier? Overall, payers are reimbursing providers faster (up 5.3% from last year) and denying 9% fewer claims.

That’s according to Athenahealth, an online medical billing service that has ranked…

CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59

Posted on 07. May, 2009 by Editor.

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No more black box at Cigna.

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…

Insurers Offer to Charge Sick People Less …

Posted on 01. Apr, 2009 by Editor.

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… and healthy people more.

In an unexpected move last week, Karen M. Ignagni, president America’s Health Insurance Plans, told lawmakers that the health insurance industry is willing to change its policy of charging sick people higher premiums, reports The New…

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10 Carrier Contract Negotiation Tips

Posted on 06. Mar, 2009 by Editor.

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Carrier contract negotiation is often a long, difficult process. If you don’t ask the right questions, you could end up in a binding contract that doesn’t work well for your practice. Don’t sign a new carrier contract without…

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Show Us the Money for Primary Care

Posted on 05. Feb, 2009 by Editor.

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Almost everyone agrees that federal and private insurers should reimburse primary care doctors more for their E/M skills and preventive care work.

But where should that extra reimbursement come from? Let’s lower the reimbursement specialists receive so we can pay…

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BS California Restores Dropped Patients, Settles $12.6 Million Suit

Posted on 15. Jan, 2009 by Editor.

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“Rescission.” No, it’s not a procedure you need to look up in your CPT book. It’s a fancy word that describes what happens when an insurer drops a patient who is sick.

Insurers say patients aren’t up front about pre-existing…

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Evercare is ‘Nevercare’ to Some Texas Benes

Posted on 09. Jan, 2009 by Editor.

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UnitedHealth Group unit has blown benefits administration, newspaper says.

Some providers and coders complain that UnitedHealth Group is a big giant that ignores the rules. Add ‘Don’t Mess With Texas’ to the list.

For several years,…

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