October 26, 2017

For each new plan year for the past decade, health plans have imposed higher medical deductibles upon Americans to use their health benefits.  Except for annual physicals, routine office visits and immunization shots, this means patients have to pay more out-of-pocket...

October 3, 2017

Long gone are the days when a patient with a health plan meant predictable, reasonable payments for the medical provider.  Reimbursements to medical providers have steadily decreased over the last two decades.  During the same time period, the cost of running a busines...

As Congress debates its replacement for ACA, we can all appreciate the enormity of trying to balance sustainable benefits for Americans while reducing the financial burden of providing those benefits.  And while there was much uncertainty surrounding the American Healt...

April 26, 2017

The Employee Retirement Income and Security Act of 1974 (ERISA) requires that plan sponsors of group health plans comply with certain disclosure requirements including the requirement to supply employees with a Summary Plan Description (SPD). To be legally compliant wi...

April 23, 2017

In Network vs. Out of Network Care - Fair Health Know Your Source Publication

I happened upon this publication recently by FAIRHealth.org concerning a topic that is top of mind as a medical billing entity. I have, as of late, been rounding back to print material (wearin...

October 23, 2016

Cost constraints often hinder facilities from attaining the most sophisticated scrubbing platforms to ensure minimal error rates and billing efficiencies. Staff attrition can also create deficiencies in an atmosphere that continues to grow in complexity. And lastly, ca...

October 13, 2016

ERISA was enacted in large part to protect pension plans. It also imposes significant obligations onto qualified health and welfare benefit plans (QHWBP). Title I of ERISA contains a strict fiduciary code of conduct that must be adhered to by both plan sponsors and adm...

October 13, 2016

Training Staff to navigate the often uncertain terrain of financial communications is a challenge in itself.  How do you prepare and train your staff for what may sometimes turn into a rather heated discussion?

First, acknowledge that such discussions are only ine...

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Pre-Authorization of Services: A Proliferating Roadblock to Patient Care and Payment

October 3, 2017

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