Matthew Stroud Hellebusch’s Post

The willy nilly approach to cost containment by networks is arbitrary and embarrassing. The days of spaghetti on the wall are over. Medical bills must be cleaned for errors, waste, and inflated charges based on the actual treatment provided. When claims need to be repriced reimbursement must befair and reasonable for the patient, payor, AND provider. A payment integrity service must know how to pay claims AND have integrity.

https://lnkd.in/etEMHtZD How many stories do we have to read about payers and their surrogates putting profits before patients and ruing lives before we do something about it? There is an easy solution. Make it a federal law that any MD that signs off on a delay or denial of care is practicing medicine. They should have to meet all the requirements to practice medicine AND be liable for malpractice when they make a bad decision. No more hiding behind algorithms or the statement, "we aren't saying the patient can't get the care, only that we won't pay for it." Want to make it even more powerful? Make their employer liable for treble damages when a case is won. If the payers are so convinced that they are following good medicine and that they are right this shouldn't concern them at all.

Nearly 50 Australian specialists, including anaesthetists and surgeons, are accused of charging unauthorised fees of up to $5,000 under "no gap" or "known gap" arrangements, despite claiming bulk billing with Medicare. These allegations, termed "shadow billing," highlight potential large-scale fraud, undermining trust in healthcare and the accuracy of Medicare and insurance data. Read the full article: https://lnkd.in/gfQnFx7M #HealthcareEthics #NoGapFee #PatientAdvocacy #TransparencyInHealthcare

Every month, we find the industry's most relevant news and opinions and share them on the MGIS blog. Here are June's highlighted articles: - Doctors Hit Their Breaking Point as 86% Fear for the Future of American Medicine - Gen Re Reveals a Boost in Individual Disability Insurance - Physician Burnout by Specialty & Other Physician Mental Health Statistics - MGMA Report Highlights Productivity Gains and Rising Physician Compensation Despite Industry’s Staffing Shortages Stay up to date with the latest industry news and updates by clicking here https://lnkd.in/gGcMCaqs #MGIS #industrynews #doctors #burnout

I just learned there is an incredibly important bill before the Medical Health and Addiction committee in the Illinois House! Bill HB4475, HA1 will make many significant changes to the Illinois Insurance Code. These include: 1. Equal Payment with Primary Care to Grow Access & Increase Network Participation Sets a minimum reimbursement from private insurers for in-network MH/SU care based on the Milliman analysis: 141% of the Medicare rate (Milliman inflation-adjusted) to put behavioral health on par with other healthcare.   2. Utilizes the Full Behavioral Health Workforce Allows MH/SU providers working toward licensure to practice under the supervision of another fully licensed provider, consistent with many major insurer practices.   3. Requires Coverage of MH/SU Services Received on the Same Day   4. Requires Coverage of 60-Minute Therapy Prohibits the use of excessive documentation or more frequent insurance audits that drive therapists to use shorter 45-minute sessions.   5. Requires Timely, 60-Day Contract Process for becoming an In-Network MH/SU Provider PLEASE click the link below and sign a witness slip to support the Bill. How to Slip: https://lnkd.in/gzaVvKJX.  1. Fill out your name/address/contact info. If you are slipping on behalf of your organization, use your business address. Use your personal info if you are doing this as an individual. 2. Firm/Agency: Your organization; If you are doing this as an individual, put “Self” 3. Title; If doing this as an individual, put “Self” 4. Persons/Groups Represented: Organization or Self 5. Position: Be sure to check PROPONENT! (Make sure HCA1 is checked - this is House Committee Amendment 1) 6. Testimony: Check “Record of Appearance Only” (This means you are showing your support but are not speaking or submitting written testimony) 7. Agree to the Terms: Check the box 8. Create Slip/Captcha: Click the “Create Slip” Button 9. You should get an email receipt of your “Slip” #IllinoisGeneralAssembly #IllinoisHouse #MentalHealthandAddictionCommittee #IllinoisBillHB4475HA1 #IllinoisInsuranceCode #RelationshipSolutionsCenter #RSC #TransformingLivesAndRelationshipsFromTheInsideOut #Mentalhealthmatters #MentalHealth #MentalHealthSupport #MentalHealthWarrior #MentalHealthAdvocate

Open Enrollment has started! 📣 Medicaid redeterminations have left many without coverage in TN and VA. Finding affordable coverage is possible! TN residents can find a plan that meets their needs via healthcare.gov & VA residents can too via marketplace.virginia.gov. Both states have “assisters”, who are not brokers, who assist consumers with finding a plan that aligns with their needs and within their budget. Please share this information and these resources with your patients. More often than not, we see our patients deceptively enrolled in plans they cannot afford with benefits that hardly cover their care, without their knowledge. We at NLM believe that insurance should not be a barrier to treatment! Patients should not have to pay hundreds out of pocket for life-saving addiction treatment. NLM > Cash Clinics #addictionmedicine #MAT #newlifemedicine #mentalhealth #primarycare #virginia #tennessee

Have you read the Quality of Life Report put out by the House Armed Service Committee? It is so much easier to blame someone else than look for how you contribute to the problem. We do it in all relationships including marriage, work, and the institution (Department of Defense) is no different. While it is true that there are civilian mental health shortages, the real question we should be asking is “Why?” There are more shortages of Tricare providers than other insurance companies. The mistreatment and bureaucracy providers experience with Humana and HealthNet is one of many reasons why providers are leaving. After asking the Board of DHA to survey why providers were leaving Tricare contracts, they were dismissive and wanted to only survey beneficiaries which would reveal what we know already- there are not enough providers. Instead, we were able to get it into the Quality of Life Report that will make its way into NDAA25. This is not hard. As a parent, it always goes better when your child admits where they could do better rather than exhausting effort, time, and risking the continued decline of trust by me having to dig and find the issues myself. Special thank you to Heba Abdelaal who did not get thanked for her involvement and contributions to this report. I am beyond humbled to know you. To read the full report: https://lnkd.in/gZuC2HEz

UnitedHealth uses an algorithm to limit therapy coverage, a practice illegal in several states. Despite scrutiny, cost-cutting measures continue, leaving patients without necessary care due to inconsistent enforcement. https://lnkd.in/e58z_8Bt

ICYMI, there was a big bust on Medicare fraud this past week. Read about the details here and how vulnerable seniors were duped into unnecessary genetic testing. Terrible news. https://lnkd.in/d2KAMp5U #health #healthinsurance #medicare #medicarefraud #insurance #healthinsurance

The #ACA eliminated out-of-pocket costs for preventive care, but lower income, non-white patients are more likely to be incorrectly charged for services. Further, #contraceptive and #mentalhealth screenings had the highest erroneous denial rates. Compounding it all, at-risk patient groups are the least likely to appeal denials. Digging into the root causes of billing errors can help both the bottom line and #healthequity achievement.