Phia Group

No News Is Good News For Healthcare Providers

On February 9, 2017
Much like a pendulum, there is a swing from right to left with different sides trying to tell their message and incite a reaction; a swing not seen on such a public scale in our own Health Care Industry.

Overpayment Success Story: Dialysis Claim

On February 9, 2017
A dialysis claim was adjudicated at the regular out-of-network rate instead of the dialysis carve-out rate of 130% of Medicare.

Self-Funded Employers Beware the Network!

On February 8, 2017
Self-funded employers should be careful when selecting networks. In some cases, low discounts, anti-audit clauses, unseen provider agreements, and upside-down DRGs can cause more problems than the network access is worth.

The Details of Your Coverage Plan Matter

On February 8, 2017
Employers face many, many regulatory burdens. There is an ever-increasing number of federal regulations to abide by, and each state maintains its own set of regulations

A Canadian Pays Cash for Care – Part One

On February 8, 2017
I paid for the procedure, had no claim to worry about, and the care was excellent. Read more about how I did this.

Mental Health Parity and Claim Negotiation

On February 8, 2017
When choosing claims to have negotiated, don’t worry about mental health parity. While it’s an important set of laws, it primarily protects patients from having higher responsibility. Read More.

Call Me Corny: Discussion on Healthcare

On February 6, 2017
Healthcare in our country is too expensive. The money is being spread around, and wasted. Is there greed? Sure. But there is also inefficiency.

10 Things to Know About Athena Health

On February 6, 2017
Here are 10 things to know about Watertown, Mass.-based athena health, one of the largest publicly traded companies in the world providing medical record

As language shifts to ACA ‘repair,’ Pence reaffirms commitment to ‘repeal and replace’

On February 6, 2017
Although some Republican lawmakers have begun to discuss a more tempered goal of “repairing” the ACA instead of tearing it down, Vice President Mike Pence on Thursday said the Trump administration is still committed to repealing and replacing it

I Have A Bridge to Sell You- Healthcare Discussion

On February 6, 2017
As long as we make decisions based on extremes intended to sell headlines or keep an elected post, we’re missing the point.

ACA Section 1557 – Federal Court Injunctions, Executive Orders, Repeal/Replace, Oh my!

On February 3, 2017
A federal court injunction related to 1557 was granted on 12/31/16, temporarily stopping portions of the rule—discrimination on the basis of gender identity & termination of pregnancy—from becoming effective.

Massachusetts Braces for ACA Repeal

On February 3, 2017
A number of state lawmakers, consultants, and industry experts offered their opinions on how the Commonwealth could move forward in a post-ACA world.

Enough to be Dangerous- Benefit Plans discussion

On February 2, 2017
One issue I’ve been running into relates to attorneys that “know” benefit plans are required by law to provide a notification of adverse benefit determination any time they pay less than the charged amount.

Change Often Starts with a Conversation

On February 2, 2017
My wife, quite literally, has no idea what I do for a living. When friends and family ask, she normally replies, “…he does something with subrogation…and it involves health insurance.”

An Unlikely Recovery

On February 2, 2017
The Phia Group’s overpayment specialists received two claims – same provider, same patient – totaling over $760,000. The reason for the refund was that the original repricing was incorrect.