Uncovering Healthcare Profitability

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How to Avoid Problems Caused by Out-of-Network Claims and Bills

It used to be that we patients could make an appointment with just about any doctor or hospital we wanted to, and not give any thought to whether or not our insurance company would pay for those appointments or hospital stays. However, that is no longer true. As health insurance options and costs become more […]

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Privus Healthcare Hosting Blood Drive

Privus Healthcare Gives back to its community in many ways. Over the years we have donated water, collected Gifts for Sick Children, Given to animal shelters, and much more. Privus would like to announce its latest efforts to give back. On October 14th Privus will be hosting a Blood drive within its Phoenix office. We […]

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1 In Every 25 Hospital Patients Will Acquire An Infection

After a standard gall bladder removal surgery, Alicia Sheerin, 45, developed necrosis at the site of the incision from the procedure. This low-grade infection increased Alicia’s hospital time from less than a week to almost a full month. Once Alicia was released from the hospital to return home, she had to hire a home health […]

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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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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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