We recently attended the HFMA Arizona Fall Conference. Here are three things we heard over the course of many insightful sessions and discussions:
In the state of Arizona, providers have the right to request an Independent External Review if your payors have denied claims, even after you have appealed! If you disagree with the payor's decision, you can submit a written request to the payor asking that an independent, external review be conducted. This policy applies to only fully insured commercial carriers in the State of Arizona. You must follow plan requirements for non-fully insured commercial plans, such as Medicare/Medicaid, self-funded employer plans, etc.
Keynote speaker Reggie Hodges, former NFL player encouraged us to ask “Who do you want to be?” Not, “What do you want to be”. Be remembered for the type of person you are, not what your job title is.
Marcus Johnson, AHCCCS, shared that more than 100 Arizona healthcare providers are under investigation for insurance fraud that targeted the state's Native American population and are suspected to have defrauded the state's Medicaid program by hundreds of millions of dollars. The providers under investigation include a variety of behavioral health, residential and outpatient treatment facilities. Often referred to as "sober living facilities", it is alleged that many of the named facilities do not actually provide the services they are being reimbursed to provide. Instead, it is alleged that patients are left untreated and sometimes given drugs and alcohol to continue to feed their addictions.