In New Jersey and surrounding areas, Aetna offered a special Medicare Advantage plan to retired state employees and other retiree groups. This plan is called a Medicare Advantage PPO ESA plan….
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Healthcare is changing fast, and acupuncturists need to pay attention. Two of the biggest developments I am watching right now are Value-Based Care and increased reimbursement audits. Both point to the same conclusion:…
This builds on my other article about prompt-pay discounts and sliding scales—because this is where a lot of providers unintentionally get themselves into trouble. First, let’s clear up some common…
Beginning in early March, acupuncturists—primarily on the East Coast—began reporting recoupments involving patients with Medicare Advantage coverage. Below is a summary of the known facts at this time: In practical…
The typical reimbursement for medical providers is called a Fee-for-Service model this is where providers are paid for the services they provide, with no real oversight as to how the…
Between 2021 and 2023, health insurance companies issued more than 49 million claim denials annually. But here’s what made regulators sit up and notice: Less than 0.2 percent of patients…
1. The DOJ is investigating Medicare Advantage Plans The Federal False Claims Act (FCA) is a law that prohibits knowingly submitting false claims for payment to government healthcare programs like…
I’m increasingly seeing providers use codes for services that are not typically performed in acupuncture clinics. When questioned, the common response is: “I’m getting paid, so it must be okay.”…
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