Proper Billing & More

Streamline your medical billing and allow us to handle the complexities. Contact us for a hassle-free experience.

Beginning Tuesday, November 1, 2022, consumers are able to sign up for high-quality, affordable health insurance on HealthCare.gov. Marketplace Open Enrollment runs from November 1, 2022, to January 15, 2023. Anyone who enrolls by midnight December 15, 2022 can get full-year coverage that starts January 1, 2023.
The Centers for Medicare & Medicaid Services (CMS) continues to invest in the consumer experience to make it easier for people to sign up for coverage. Thanks to the American Rescue Plan and the Inflation Reduction Act, both signed into law by President Biden, a majority of people continue to have access to affordable premiums that help lower costs for families. Four out of five customers will be able to find plans for $10 or less per month after tax credits. Families who have found employer insurance unaffordable in the past should look at new opportunities for savings on HealthCare.gov.

Contact my office for assistance with picking the right plan for you & your family. Proper Billing & More

Proper Billing & More

The Accountable Care Organization (ACO) demonstration for Atlanta, GA beneficiaries, Kaiser Permanente, a TRICARE Prime Option is ending.
September 19, 2022
The Accountable Care Organization (ACO) demonstration, Kaiser Permanente, a TRICARE Prime option, ends on Dec 31, 2022. If you have this plan, you must change your Primary Care Manager (PCM) to a new TRICARE network provider or enroll in TRICARE Select during TRICARE Open Season. For 2022, Open Season is from Nov 14 to Dec 13, 2022.

Talk to your doctor about prescriptions you have with Kaiser Permanente. Also, ensure you have the right amount while you transition to a new provider. More details about continuity of care, claims, prescriptions and referrals are forthcoming.

Note: The Accountable Care Organization (ACO) Demonstration was developed/implemented by the Defense Health Agency (DHA) to conduct and evaluate value-driven initiatives in an effort to move from a volume-based reimbursement system to a value-based reimbursement system for health care services. The Demonstration was contracted for three years, which allowed DHA to gather knowledge from lessons learned and improve on initiatives that will drive future expanded iterations of value-based care models.

What Is “Surprise Billing”?

Surprise billing commonly occurs when a patient is treated by an out-of-network professional or treated at an out-of-network facility. This can happen during emergency situations such as when a patient is taken to an out-of-network emergency room or is transported by air ambulance.

Surprise billing can also occur in non-emergency situations, such as an out-of-network anesthesiologist treating a patient at an in-network facility. Typically, in these cases, it is only after services are provided and a bill or benefit statement is received, that the patient learns that the anesthesiologist was an out-of-network provider.

The patient is faced with an unexpected “surprise” bill from the out-of-network provider seeking to recover the balance from what the health plan paid to what the out-of-network provider charged. The amount of these surprise bills can be substantial.

When Does The Law Go Into Effect And What Does It Do?

Starting January 1, 2022, the No Surprises Act generally prohibits providers from balance billing patients* for:

Out-of-network emergency items and services
Out-of-network non-emergency items and services provided in an in-network facility
Out-of-network air ambulance healthcare items and services
*There are some exceptions based on provider notice and member consent.

Under the Act, a health plan reimburses the out-of-network provider an initial payment on the charges. If the provider does not agree with the payment amount, the provider has 30 days to negotiate different amount with the health plan.

Providers and health plans are provided a number of opportunities under the Act to settle on a payment amount. If reimbursement cannot be settled upon, then either the provider or health plan may invoke arbitration. In arbitration, both parties submit a proposed payment for the services, the arbitrator then must select one proposed payment, with no ability to split the difference between the two proposals.

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