Uncovering Healthcare Profitability

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Phoenix Women Stuck With $6,312 ‘OON’ Bill

Eve Miner does a lot of walking these days to improve her health. In addition to walking, one of her favorite workouts is getting out her bike and taking it for a spin a couple times a week. “I’m always going up and down Central Avenue, and everyone is always walking and riding their bikes […]

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Why ICD-10 Matters

It’s an exciting time of healthcare reform for the United States and a lot of that excitement revolves around the transition from ICD-9 to ICD-10. If you’re asking yourself what is ICD-10 and why it is important, then you’ve come to the right place. ICD-10 or a clinical modification of ICD-10 is the classification system […]

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The United States Capitol building

Are You Ready For The Big Code Change

We are – we have you covered! ICD-10-CM diagnosis code set is replacing ICD-9-CM coding on October 1, 2015. Important: All providers, payers, clearinghouses and billing companies are required to undergo the change from ICD-9-CM to ICD-10-CM. The change to the new code set will be effective starting on October 1, 2015. All services and discharges […]

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UnitedHealthcare Services Denied Injunction Against Out-of-Network

In UnitedHealthcare Servs., Inc. v Asprinio (2015 NY Slip Op 25298), decided on August 31, 2015, in the Supreme Court of Westchester County, UnitedHealthcare suffered a set-back against attempts to prevent balance billing by an out-of-network physician. In this case, UnitedHealthcare (“United”) brought an injunction action against an out-of-network (OON) orthopedic physician and his medical […]

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Aetna Improperly Denies or Underpays Out-of-Network Claims

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special Surgery) filed suit in Harris County District Court against Aetna Health Inc. and Aetna Life Insurance Company (Aetna), claiming that Aetna underpaid or […]

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An Apple a Day

You’re likely familiar with the old saying, “An apple a day keeps the doctor away.” But did you know June is National Fruit & Vegetable Month? According to the USDA, Americans should consume about 1 ½ – 2 cups of fruits and 2 – 3 cups of vegetables per day. Fruits and vegetables contain many […]

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How Do You Wear Your Scrubs?

The medical field is not like it used to be. And neither is medical wear. A recent Medline University poll of 1,400 healthcare workers from hospitals, nursing homes and other patient care settings found that nearly 60 percent have some choice in the scrubs they wear to work. Respondents also stated the most important features […]

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It's not that some people have willpower and some don't. it's that some people are ready to change and others are not.James Gordon


HCAHPS Star Ratings

When I was raising my daughters, I often told them to reach for the stars. When they were little, it was just a way to get them to raise their hands so I could clean a highchair tray or wipe a face without sticky little fingers getting in the way. As they grew, it became […]

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