Integrity MBC

10/18/2022

https://www.justice.gov/usao-sdny/pr/united-states-files-civil-fraud-lawsuit-against-cigna-artificially-inflating-its

Department of Justice U.S. Attorney’s Office Southern District of New York FOR IMMEDIATE RELEASE Monday, October 17, 2022 United States Files Civil Fraud Lawsuit Against Cigna For Artificially Inflating Its Medicare Advantage Payments Damian Williams, the United States Attorney for the Southern Di...

06/03/2020

Instead of having a question this week, we feel it is our duty to let our clients and customers know where we stand. We are a company that hires all. We treat all people fairly and just. We hope to have a safer and better place for all Americans, especially those treated unfairly. If this belief pushes away a client, we wish we could’ve lost you sooner.

05/26/2020

Q: I had services performed that I was told are covered by my insurance. I’m now being told that insurance didn’t cover it and I’m being held responsible! Why was I told it was covered, and now being held responsible for a bill?

A: Coverage of benefits differ greatly from who the responsible party is for payment. As always, if the benefit goes toward your deductible, you’ll owe this and a co-insurance until/ if you are covered at 100%. If you’re being denied on a covered service, did your records prove the medical necessity behind coverage? This means- 1: Did the claim record (UB04/ HCFA) have the appropriate diagnosis pointers assigned? 2- Did records support the claim form and medical necessity.

Often, certain procedure codes are only covered under specific diagnosis codes. Each carrier has their own rules, so it’s imperative for the procedure to be coded and billed appropriately. This does not mean a Coder or Biller will add codes for payment. If the medical records reflect the payer rules, they’ll bill it out accordingly to ensure a claim is not denied. It’s important that whomever is handling billing stays current on payer rules to minimize denials and cut back patient frustrations.

If this is a common issue in your practice, feel free to reach out for assistance. We do consults as well!

05/19/2020

Q: My insurance said my copays would be waived during this time, but I received a bill with a balance. Should I pay this?!

A: Many insurance companies are waiving patient cost-sharing during this time. It may vary from just co-pay, or it may include deductibles and co-insurance. Depending on your plan type, the services you received may or may not fall into this category. First, is it an actual bill, or an EOB from your insurance carrier? Second, call your insurance company to find out if this service was truly a service that fell into your cost-sharing waiver or if you may owe an amount for services rendered. Find out all you can about your plan benefits and the waivers that are currently being offered so you may understand your benefit levels. Make sure to get a reference number for your call and communication. If what you received is an EOB, no need to contact the provider just yet. If what you received is a bill and it goes against what your carrier told you, contact the provider’s billing office and tell them what you were told by your carrier. Include the reference number you received so they can use it to help handle this for you as effectively as possible in a time efficient manner. If the representative you speak to in unaware of what to do, ask for a manager. If the manager doesn’t know what to do, you may want to talk to your provider about their billing process. Feel free to have them look us up to provide services.