Tag: Insurance

Posted in In The Know Series, Insurance, My services

UHC buys POMCO insurance. UMR is the third-party administrative payer

Posted on by KR2Medical Billing

In March of 2017 there were talks of UHC (UnitedHealthCare) buying POMCO, a third party insurance administrator, located in Syracuse NY.

POMCO is the largest benefit administrator for self-funded and risk management plans in the nation. They offer dental, vision and medical benefits to different types of employees in NY, both state and Westchester County employees.

POMCO had suffered a previously a loss of letting go more than 100 employees after Health Republic of NY, was forced to close by the state and federal regulators.

But lets get back to UHC buying out POMCO – UHC hopes to expand into the Central and Upstate New York areas; offering medical coverage to patients to its multi level of professionals.

UPDATE: 

IN APRIL 2017, the purchase of POMCO by the UHC was finalized! The purchase price was not disclosed.

 

Posted in Insurance

ICD-10…more responsibility for providers?

Posted on by KR2Medical Billing

So, I took a ICD-10 training course from AAPC, for professionals. I have to say that from a Medical Biller perspective I didn’t see a lot of drastic change. However, there was a lot more change for the providers/doctors.

Those of you who have been documenting extensively for your patients have nothing to worry about….Yes, it will take a while for the payers to start processing your claims correctly and get payment. But you will have a less change of a rejected or denied claim, based on the simple fact that your diagnosis did not correspond to the treatment codes and you have no supporting documentation to show for it.

ICD -10 are more focused and more detailed but they are also more descriptive and require the supporting documentation to accompany the diagnosis.

There is more pressure on the provider to make sure that the documentation is correct so that the coder could select and code the diagnosis properly.

Please do not be discauraged. There is plenty of help…Courses from AAPC or even Availity. Or maybe you prefer a mobile approach of having an app on your phone with the ICD-10 refences. Of course, lets not forget your EHR/EMR software which could be quiet useful.

So, cheer up and brace the new ICD-10 with open arms and ease!

Posted in Insurance

Exchange plan buyers beware…

Posted on by KR2Medical Billing

Recently, I had the pleasure of meeting and with a Merk rep, Gina. I always get plenty of reps during my time @ Dr. Celina John’s Office. The visit is usually involves the doctor and the rep. However this time both her and I struck a coversation about medication coverage and pharmacies.

Although, I personally do not have this problem with pharmacies I found out from Gina that she was a victim of a pharmacy charging her a $120 copay for a medication (generic)?!

She, just like many other thousands of people has an exchange medical plan and until recently she thought that she would have no problem of using her local pharmacy for her medications. But to her suprise, she paid a whoping $120 copay for a medication that she thought had no copay at all. Why this happened? Well, it’s because that particular pharmacy was OON (out of network) with the particular exhange medical plan that she acquiered. What?! I personally do not know any doctor office that takes a copy of your pharmacy card. I always ask the patient for their pharmacy information-for escripts purposes.

In the end the moral of the story is that anyone that has an exchange medical plan please call the pharmacy number on your card and find out if a particular pharmacy you are going to use is INN (in network/ participates) with your plan. This way you will avoid those costly $120 copays, like Gina had to pay, and obtain your medication for low or no copay.