The Texas Medical Board and Dept of Health & Human Services are the regulatory groups that oversee the release of medical records and set the maximum fees that can be charged.

I would be looking into your state regulatory groups–depending on the state laws, that might be the best way to get this doctor/clinic to comply.

Then again, this all…[Read more]

I 100% agree! I’m currently awaiting a response from my certified letter to the compliance manager and will keep you all posted on how things turn out.

Thanks so much!

Jennifer Kastner

Good questions, Lisa.

You will have access to course materials as long as you remain an APHA member – for years, if you choose that! As long as you can log in to myAPHA, the lesson pages and videos will be available to you.

re: your idea for a course… As you probably know, since we have new APHA directors, I am no longer the decision maker…[Read more]

Sorry I had to miss the calls, I was on vacation in New Orleans. Hope there is a way to listen to them.

Many Blessings to both of you!!

Thanks everyone for all the valuable feedback! Things got weird once the other doctor (not the one my client is seeing) got involved. I think I now know the motivating factor from the doctor – my client’s first two claims were processed and shows what I’ve been telling them. They billed over $1000 for first visit and $7600 for second!

Shout…[Read more]

Hello everyone,

Deb and I enjoyed “meeting” so many members on yesterday’s zoom calls. Please be on the lookout for the post-meeting summary that highlights the discussion. And, if anything comes up/crosses your mind/burning thoughts, please email us at: dena@aphadvocates.org (so exciting to write that!) and deb@aphadvocates.org.

Stay in touch…[Read more]

a Medicare patient can ONLY be billed if the Medicare EOB states so. When a patient signs an ABN, the office must code the charge indicating which choice the patient made on the ABN. This will therefore change whose liability a denied claim becomes. A merely signed ABN does NOES allow a provider to bill a patient if the EOB says it is their…[Read more]

use the same documentation that got the current authorization in your appeals to the Claims department for past services. Of course, you should also include the new authorization.
In some cases, you might be able to get the auth retroed to the first date of service buy calling the UM department, but it is difficult to do so for a previous year…[Read more]

it happens when an allowance has changed, usually at the beginning of the year, and the billing department at the doctor’s office has not adjusted their pricing accordingly, using the previous allowance as billed amount.

Gail – unless the wife is incompetent, and unable to make her own decisions, SHE is the client – not the spouse. Yes – it was a problem with the husband’s insurance, but she was the user of that insurance.

That doesn’t mean they can’t both be part of the work, and that you can’t discuss it with them both. It’s just that it was HER healthcare…[Read more]

Hi Gail,

My thoughts on your situation: Even though the wife is dependent on the spouse’s insurance, the wife will have their own policy #. I feel that the wife will be the patient and the spouse is the paying client. From my days working for Insurance, you would still need a signed release to speak with the spouse on the wife’s behalf. When…[Read more]

Hello Marc,
Without knowing your background, it is difficult to give any “relatable” feedback. As with many standardized tests, there can be what seems like multiple correct answers, or none that are correct at all. (Ugh!). My best advice would be to keep things as simple as possible and try not to read anything into the answers. Our…[Read more]