McGrew Miller Bomar & Bagley, LLC’s Post

The significance of physician contracting review committees really can't be overstated. Engaging subject matter experts in contract reviews helps mitigate the risks associated with Stark regulations and prevents oversight of potential self-referral issues. #PhysicianContracting #HealthcareCompliance

What is a Lien? • Purpose: A lien is a legal claim or "hold" on a patient’s settlement funds, guaranteeing that the healthcare provider is paid for the services rendered. Liens are typically filed in personal injury cases, including slip-and-fall, workers' compensation, and motor vehicle accident claims. • How it Works: Once the lien is filed, it ensures that the provider is paid directly from the settlement or judgment proceeds. This protects the provider's right to reimbursement before other financial obligations are settled. • Medical Billing Role: Managing liens involves coordinating with legal teams, maintaining detailed records, and tracking liens through to settlement. Knowing state-specific lien regulations is also crucial, as lien laws can vary significantly. Key Differences Between LOP and Liens: • Agreement Type: LOP is a written agreement involving the patient, while a lien is a formal legal claim filed on the settlement. • Security of Payment: Liens provide stronger legal backing, as they are filed directly against the case, while LOPs rely on the attorney's commitment to honor the payment. • Application: LOPs are often used when patients cannot pay upfront, while liens are more common in cases where healthcare providers want a stronger guarantee of reimbursement. Importance of LOP and Liens in Medical Billing: • Cash Flow: LOPs and liens provide a means for providers to treat patients without immediate payment while securing future reimbursement, ensuring both patient care and provider cash flow. • Tracking and Follow-up: As a medical biller, I track these cases closely, coordinate with legal teams, and manage follow-ups to guarantee that providers are compensated for the care they provide. • Patient Impact: LOPs and liens allow patients to access necessary care without worrying about immediate out-of-pocket costs, which can make a significant difference in their recovery. By navigating LOPs and liens effectively, I help ensure that providers are reimbursed and patients receive the care they need, even in challenging financial situations. #LetterOfProtection #LOP #MedicalBilling #HealthcareBilling #Liens #PatientCare #Reimbursement #PersonalInjury #InsuranceClaims #BillingCompliance #AccidentClaims #Attorneys #Paralegal

Most doctors didn't spend 8 years becoming specialists, only to have to learn how to negotiate with healthcare payers. It's the theme we hear from all of our 80+ clients—they prefer to focus on providing exceptional care, not managing and negotiating payer contracts. Aroris is a team of payer analysts, legal contract experts, and negotiators who come alongside healthcare providers to take ownership of payer contracts to ensure they are generating the right level of revenue for providers. Learn more about our “High Reward, No Risk” promise. Our compensation is generated by the increased revenue we negotiate for your practice. To date, we’ve generated over $30M in additional revenue for providers.

With the extensive reimbursement cuts of 2023 and 2024, medical practices are urgently pursuing ways to optimize their revenue while maintaining compliance with regulatory standards. One strategy that is often seen as an elusive unicorn for physician practices is making incident-to-billing work on all the right occasions, compliantly.  https://lnkd.in/e3AT2CAJ

Understanding LOP (Letter of Protection) and Liens in Medical Billing: Ensuring Provider Reimbursement and Patient Care In medical billing, LOP (Letter of Protection) and liens play a critical role in ensuring that healthcare providers are reimbursed for treating patients involved in personal injury cases. Here’s an overview of what LOPs and liens mean, their purpose, and how they impact medical billing. What is a Letter of Protection (LOP)? Purpose: An LOP is a legal agreement between a patient, their attorney, and the healthcare provider. It allows the patient to receive medical care with the promise that the provider will be paid from any future settlement or verdict. How it Works: When patients can’t pay upfront due to financial constraints, an LOP assures the provider that payment will come directly from the settlement once the case is resolved. This can be critical in personal injury cases, especially those that take time to settle. Medical Billing Role: As a medical biller, managing LOPs requires ongoing communication with attorneys to monitor case status and ensure the provider's interests are protected. Tracking these cases carefully is essential to avoid delays in payment. Liens will be discussed in the next post, along with a comparison between them. I couldn't cover everything in this post. #LetterOfProtection #LOP #MedicalBilling #HealthcareBilling #Liens #PatientCare #Reimbursement #PersonalInjury #InsuranceClaims #BillingCompliance #AccidentClaims #Attorneys #Paralegal 

Okay - I get it. You don't like PE firms buying medical providers. Let me ask the questions that has apparently escaped California and Massachusetts: 1) How is PE ruining the medical world? The article states, "higher costs for patients and insurers, lower quality of care, and worse financial outcomes for entities acquired." Sadly, most medical practices don't control their pricing. The "normal and customary" pricing for any procedure is set by insurance or Medicare contracts. How can they raise prices on patients or insurance companies? And the quality of medical care is fully regulated. If a doctor / dentist / whatever is not caring for their patients properly, the medical board from thst state gets involved. How can PE affect that? 2) Why are they buying? The obvious answer is because someone is selling. And for most smaller medical practices, the choices are sell or close. 3) What is the alternative? If it is closing, that seems to have a worse effect on medical care than PE buying it. If they can only sell to other medical institutions, this will devalue all medical practices and create new problems for doctors and patients. In short, as with most legislation these days, how do these bills help anyone? https://lnkd.in/ghSmHS9H

How does this happen? Allowing individuals to make crucial medical policy decisions without being a Physician? It's fascinating how easy it is to deny services but not check credentials! #Epimed #PhysicianServices #Trustbutverify

The federal Anti-Kickback Statute (AKS) is straightforward in its aim—don’t offer or accept anything of value in exchange for patient referrals! Violating this law is a felony and can lead to substantial fines. However, one nuance often overlooked is that even sophisticated arrangements designed to reward referral sources remain kickbacks. The more "elaborate" and intricate the setup, the more suspicious it becomes to regulators, including the Special Investigative Units of commercial insurers. Consider a recent case involving an NC doctor and a clinical lab, which resulted in a $625K settlement with the DOJ. This medical practice: Was paid by the lab for phlebotomy services, Received rental payments from the lab for part of their office space, and Leased a chemistry analyzer to the lab. The DOJ's issue with these arrangements was clear—each involved some form of "payment" by the lab to the medical practice that sent patients their way. Even if a practice needs a phlebotomist for blood draws, having the lab (which processes the samples and gets paid by Medicare) pay for this service is problematic. Healthcare professionals and providers must stay alert to avoid receiving anything of value from entities to which they refer patients. This caution applies to both state or federal healthcare programs and commercial insurers. Stay informed, stay compliant, and protect your practice! #HealthcareCompliance #AntiKickbackStatute #MedicareFraud #Kickback #HealthcareLaw Florida Healthcare Law Firm

Navigating healthcare disputes requires specialized expertise. The AAA Healthcare Panel comprises over 243 industry professionals, including in-house and outside attorneys, former federal and state judges, and executives. These carefully vetted experts bring specialized knowledge to resolve complex issues efficiently. With backgrounds in healthcare law, medicine, and administration, AAA panelists offer insights into asset purchases and sales, pharmacy benefit management, payor provider disputes, and more. You can be confident that the knowledge and perspectives they bring to the #ADR process ensure faster, more effective resolutions. Learn more about the AAA Healthcare Panel: https://bit.ly/4biAcqL

Article today (below) showing how the law intended to protect members from Surprise Medical bills is likely to have an opposite effect. Here are the key takeaways: - 13 TIMES! more disputed claims in the first six month than originally estimated - The Brookings Institute concludes that the law will have the unintended effect of RAISING premiums, and give providers the upper hand in price negotiations with insurers, placing "Upward pressure on prices". Conclusion: Blue, United, CIGNA, Aetna, Humana (the BUCAH's) are fiduciary only to their shareholders, not their "members". Networks are value extraction devices. Our Solution: Independent, Fiduciary plan management with Open Access to allow members to go anywhere for care with significant incentives to access care in the highest outcome providers. $0 Deductible- ✔ $0 Copays- ✔ $0 Rx copays - ✔ If this is what you want to give to your employees, I can help- let's connect.