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Industry News & EventsMedical Tourism: Everything You Need to Know
January 4, 2018

Medical tourism is on the rise domestically and internationally, but the draw of lower prices and better care comes with physical and financial risks.

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Revenue RecoveryTricks Insurance Companies Use to Avoid Paying Claims
January 2, 2018

Medical claims can be a source of frustration for patients as well as providers. Learn some of the common tricks insurers use to drag their feet and delay (or avoid) paying.

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Industry News & EventsMental Health Insurance Coverage Challenges
January 4, 2018

Mental health care and substance abuse aren't always consistently or sufficiently covered by health insurance, causing problems for patients and providers alike

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Medical BillingHow Does Medical and Insurance Billing Work
January 4, 2018

Medical billing can seem a mystery in every way except for it’s costliness, but understanding how it actually works is crucial for providers and patients alike.

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Industry News & EventsCan Medical Bills Affect Credit?
January 4, 2018

The medical billing process is complex and confusing for everyone. But, it's a process worth understanding given the fact that medical bills can impact credit.

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Industry News & EventsThomas Force, ESQ. Lobbies Against Bill Benefiting Elite Insurers
Thomas Force
August 9, 2016

President of The Patriot Group, Thomas Force testified on Behalf of Out-of-Network Providers in New Jersey Senate

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Compliance & AuditsMaking Waives: Dangers Of Ignoring Co-payment And Co-Insurance Regulations
Thomas Force
August 9, 2016

Are you waiving co-payments? You could be at risk of an audit or fraud claims!

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Revenue RecoveryRevenue Recovery And Compliance Tips For The Out-Of-Network Provider
Thomas Force
August 9, 2016

What you should do to receive timely payments from providers, recover revenue more efficiently, and compliance strategies to hold issuers more accountable.

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Medical BillingMedical Billing Tips And Best Practices
Thomas Force
August 9, 2016

Medical Billing Tips to Increase Efficiency For Your Practice

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Industry News & EventsDisgorgement for Denial of ERISA Benefits: Awards Above Plan Benefit Amount
June 26, 2017

As you know, we have been carefully reviewing and analyzing recent case law and have found a very interesting case dealing with remedies under ERISA for denial of benefits. We have written about other ERISA issues in the past. Recently the 6th Circuit in; Todd Rochow et al. v. Life Ins. Co. of North America, case number 12-2074, (6th Cir. 2013); ruled that being awarded damages, injunctions and disgorgement under both §502 (a)(1)(B) and §502 (a)(3) is permissible. A plan beneficiary need not limit his/her damages to the plan benefits only.

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Revenue Recovery9 Tips to Receive Payment for Medical Claims Fairly and Quickly
June 26, 2017

It is imperative that the healthcare system or medical practice, provider and revenue recycle administrators familiarize themselves with the various laws and other responsibilities of the various managed care organizations. Then hold these payors accountable to the law. Remember, the "power" is with you.

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Industry News & EventsU.S. Court In NY Permits ERISA Claims Against Alleged Plan Administrator
June 26, 2017

Learn about how ERISA Laws could positively and negatively be affecting your out-of-network practice

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Compliance & AuditsThe Importance of Disclosures for the Out-of-Network Physician
June 30, 2017

Putting Research Into Practice: How to protect yourself from compliance, the rise of audits & common fraud schemes

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Compliance & AuditsWhat To Do When Faced With An Audit?
June 30, 2017

How to react to set your out-of-network practice up for success when defending an audit

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Compliance & AuditsAvoiding The Pitfalls: How To Handle Recoupment & Fee Forgiveness Attempts
June 30, 2017

What you should do to combat insurance providers attempts to bring costly claims against your practice!

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Compliance & AuditsHow To Predict The Fraud Schemes Insurers Are Banking On You Stumbling Into
June 30, 2017

Avoiding compliance issues by verifying eligibility and performing your due diligence

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Litigation & Legal TipsWarning! Why All OON Providers Should Take Notice Of The Charity Care Act!
June 30, 2017

The Simple Steps To Applying A Sufficient Sliding Scale For Patients Based On Income And Need

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Compliance & AuditsHealth Plan Recoupment Defense – How to Fight Back
Thomas Force
June 26, 2017

As you know, there have been a lot of out of network providers facing recoupments, refund demands and so called “special investigations“ (“SIU”) from insurance payers and health plans. This is a serious problem that we are looking to address on behalf of our out of network clients. We have been providing our audience and clients with tips to assist in their fight of these recoupments (take backs) over the past year. This article attempts to dig a little deeper into this issue and evaluate recent, relevant cases in the area of recoupments.

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Industry News & EventsOut-of-Network Reimbursement: Don’t Expect Insurers to Do the Right Thing
June 26, 2017

The net effect of this coordinated insurer movement is that out-of-network reimbursements will remain unreasonably low and uncustomary. At least one legislator is getting the message. Hats off to New York State Sen. Kemp Hannon, who is proposing legislation to compel New York-based insurers to reimburse out-of-network claims using the Fair Health database. I urge you to review Sen. Hannon’s proposed Senate Fair Health Bill S5068. Please get the word out. Physicians and other healthcare institutions need to alert their medical societies, the American Medical Association and their own legislators and representatives to get similar legislation passed in New York and across the United States.

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