In late 2020, the No Surprises Act was enacted into law. The No Surprises Act changes the landscape for out-of-network medical billing as the NSA regulates virtually every patient claim that will present to your practice- including those for self pay and the uninsured. The law, together with the first two of many rules that have followed, contain over 1,000 pages of new requirements that will require an in-depth understanding by your medical biller in

Read more

Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS) recently informed the House Appropriations Committee that he would be seeking feedback from stakeholders before enacting a policy to end surprise billing although he did not affirm whether he would use the formal rulemaking process. Typically, the rulemaking process sets out proposed regulations and then welcomes comments from all stakeholders. The No Surprises Act applies to ERISA self-funded and fully insured plans and prohibits

Read more

View the Article on the American Society of Plastic Surgeons Website ARLINGTON HEIGHTS, IL – The American Society of Plastic Surgeons (ASPS) – the world's largest plastic surgery organization – leads the specialty's medical professionals in navigating their practices' recovery plans. As plastic surgeons prepare to resume elective procedures, ASPS is providing its nearly 8,000 members essential tools and resources, including a comprehensive playbook with enhanced patient and staff safety protocols. The Society has also organized access to

Read more

The National Law Review posted a comprehensive rundown of what to expect on May 26th, 2020 when elective procedures resume in New Jersey with COVID-19 safety precautions in place. View the Article Here Resumption of In-Office Elective Surgery and Invasive Procedures in New Jersey Wednesday, May 20, 2020 On Friday, May 15, 2020, Gov. Murphy issued Executive Order 145, allowing physicians and dentists to resume elective surgeries and invasive procedures as of Tuesday, May 26.

Read more

NEW YORK (Reuters) - Park Avenue plastic surgeon Dr. Douglas Senderoff usually performs tummy tucks and liposuction for well-heeled New Yorkers. But with his practice suspended because of the coronavirus crisis, Senderoff wants to help colleagues on the front lines of fighting the virus in the city’s hospitals, where healthcare workers are trying to keep up with a flood of new patients. He also has an office anesthesia machine that can be converted into a

Read more

As our business continues to grow and we expand our services into new markets around the country, we will increasingly use this space to keep you informed and connected on industry news, big wins we have secured for our clients, and new caselaw and decisions in the Out-of-Network reimbursement market. Here you will find easy-to-read explanations of what’s going on around the country, as well as tips and tricks that you can use to help

Read more

  By definition, a “level playing field” is a concept about fairness where all players play by the same set of rules. The underlying assumption is transparency and consistency of the rules, their definition, and their interpretation.  In other words, a playbook that all players have access to and understand. Unfortunately, in today’s reimbursement world for out of network providers (OON), the field is sorely off balance leading to potentially hundreds of thousands of dollars

Read more

This was a 2013 case wherein the provider was able to obtain an in-network exception, but did not negotiate prior to surgery.  The complex surgery involved two co-surgeons and a physician assistant.  Billed charges totaled $412,176 for the co-surgeons, and $17,800 for the physician assistant.  The initial payment from the insurance company was $38,000 collectively for the co-surgeons and $1,680 for the physician assistant.  The provider filed a first level appeal before turning the case over

Read more

In this 2013 case, patient had no out of network benefits through a self-insured policy.  The provider was able to obtain an in-network exception for the first stage of breast reconstruction.  After our client continued care with multiple surgeries, the insurance company refused to reimburse the client for her services. The appeals were exhausted by the provider. The Howard Group filed a pre-litigation demand and full amount of billed charges totaling $155,800.00 was ultimately

Read more

This is a 2014 case wherein the provider was grossly under-reimbursed.  The billed charges were $28,500.00 and the insurance company paid $2,533.39.  The provider filed appeals, but did not receive any additional payments.  The file was then forwarded to The Howard Group at which point the appeals process had expired. Nevertheless, the group filed member appeals and ultimately received an additional payment for the provider in the amount of

Read more