Denials of Health Insurance Claims Are Rising — And Getting Weirder
Millions of Americans in the past few years have run into this experience: filing a health care insurance claim that once might have been paid immediately but instead is just as quickly denied. If the experience and the insurer’s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without reviewing the patient’s medical chart. A job title at one company was “denial nurse.” It’s a handy way for insurers to keep revenue high — and just the sort of thing that provisions of the Affordable Care Act were...
The Hidden Healthcare Compliance Risks in Cash Pay
Increasing concerns about underpayment and non-payment by insurance companies have providers focused more than ever on cash services. Many of the active and emerging players in the med spa, IV hydration therapy, and concierge medicine spaces are misguided on the issue of compliance, however. Both legal exposure and health care regulatory compliance create real risk, even in the cash pay space. Medical Malpractice & Negligence It is well established law that a cash health care business which does not seek reimbursement from insurance carriers does not require a Health Care Clinic License granted by AHCA if owned by non-providers. However, not being overseen by Florida’s health care...
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Congressional Committee, Regulators Question Cigna System that Lets Its Doctors Deny Claims without Reading Patient Files
ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox. A key congressional committee asked insurance giant Cigna on Tuesday to provide corporate documents so that lawmakers can examine the company’s practice of denying health care claims without ever opening a patient file. The House Committee on Energy and Commerce joined several state and federal regulators in scrutinizing the legality of Cigna rejecting the payment of certain claims using a system known as PXDX. Rep. Cathy McMorris Rodgers, a Republican from Washington who chairs the committee, noted that policyholders under Cigna’s Medicare...
All Florida Employers Must Use E-Verify as of July 1, 2023
The use of E-Verify has been mandatory in Florida for public employers and for private employers who contract with state and local governments or receive state incentive dollars. A new Florida law, however, will require all private employers with at least 25 employees to use the E-Verify system during their onboarding process beginning on July 1st. E-Verify is an online verification portal for employers to verify the identity of a new hire and assure he or she is authorized to work in the US. It does not replace the requirement to complete an I-9 form for all employees; it is the step that follows the I-9 completion. Additionally, the E-Verify system must be used to verify all new hires...
