Latest news with #medicalbilling
Washington Post
08-07-2025
- Health
- Washington Post
Surprise, the No Surprises Act hasn't stopped shock medical bills
Elisabeth Rosenthal is senior contributing editor at KFF Health News and author of 'An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.' Last year in Massachusetts, after finding some lumps in her breast, Jessica Chen went to Lowell General Hospital — Saints Campus, part of Tufts Medicine, for a mammogram and sonogram. Before the screenings, she asked the hospital for the estimated patient responsibility for the bill using her insurance, Tufts Health Plan. Her portion, she was told, would be $359 — and she paid it. She was more than a little surprised weeks later to receive a bill asking her to pay an additional $1,677.51. 'I was already trying to stomach $359, and this was many times higher,' Chen, a physician assistant, told me.
Wamda
24-06-2025
- Business
- Wamda
MEVP joins AppliedAI's Series A round
UAE's MEVP has joined AppliedAI's $55 million Series A round, along with G42, Bessemer Venture Partners, and strategic partner e&. The round was oversubscribed. Founded in 2021 in the UK by Arya H. Bolurfrushan and relocated to the UAE in 2022, AppliedAI leverages AI to process medical billing records and insurance claims faster and more accurately than traditional outsourcing firms. The new funding will support AppliedAI's international expansion, enhance product capabilities, and deepen its presence in the MENA region, where the company is building partnerships within the UAE's AI ecosystem. Previously, the company raised $42 million in 2022 from G42 and the Al Maktoum family. Press release: Middle East Venture Partners (MEVP), the pioneer and one of the largest venture capital firms in MENA, today announced its investment in AppliedAI as part of the company's Series A funding round alongside G42, Bessemer Venture Partners, and strategic partner e&. The investment completes AppliedAI's oversubscribed $55M Series A. AppliedAI, an Abu Dhabi-based company, has developed an AI-powered automation platform, dubbed Opus, that transforms back-office operations in highly regulated industries, including financial services, healthcare, and government sectors. The company's enterprise-grade solutions address critical digitisation needs across the region. "AppliedAI exemplifies the exceptional founders we back – talented entrepreneurs building innovative technology solutions that drive meaningful transformation in the Middle East," said Walid Mansour, Co-CEO at MEVP. "Their deep understanding of regulated environments and proven enterprise traction make them a natural fit for our portfolio as we continue building global AI leaders from the MENA region, bringing forth innovation in tech and societies alike." The funding will accelerate AppliedAI's international expansion while strengthening product capabilities and regional market presence. The company relocated from London to Abu Dhabi in 2022, establishing strong partnerships within the UAE's growing AI ecosystem.
Yahoo
24-06-2025
- Business
- Yahoo
TKSoftware Inc. Unveils ICONIC Pro: The All-In-One Medical Billing & Clearinghouse Solution
TKSoftware Inc. today launches ICONIC Pro, a unified, cloud–based platform that combines claims submission, electronic remittance, eligibility verification, and claims scrubbing—designed to simplify revenue cycle management for healthcare providers of all sizes. CARMEL, Ind., June 23, 2025 /PRNewswire/ -- TKSoftware Inc., a leader in medical billing and practice management solutions, has introduced ICONIC Pro, its next–generation all–in–one medical billing and clearinghouse platform. Built on a scalable cloud architecture, ICONIC Pro streamlines the end–to–end revenue cycle—from real–time eligibility checks to automated denial management—empowering medical practices to reduce administrative overhead and accelerate reimbursements. "With ICONIC Pro, we're redefining efficiency in healthcare billing. By unifying core clearinghouse functions into one intuitive interface, providers can focus on patient care, not claim paperwork," said Tony Kurzendoerfer, President and Chief Engineer at TKSoftware Inc. Key Features of ICONIC Pro: Integrated Claims Submission & Scrubbing: Submit claims to all payers with built–in scrubbing rules to catch errors before filing. Electronic Remittance Advice (ERA): Automatically receive and reconcile remittance advice, reducing manual posting errors. Real–Time Eligibility Verification: Instantly verify patient coverage across commercial and government payers to prevent claim rejections. Interactive Denial Management Dashboard: Drill–down reporting links directly to denied claims, enabling rapid remediation and appeals. Advanced Analytics & Reporting: Customizable dashboards highlight payer trends, denial rates, and revenue cycle KPIs to inform strategic decisions. HIPAA–Compliant Security: End–to–end encryption, multi–factor authentication, and routine compliance audits ensure patient data protection. Who Benefits: Independent Practices: Small to mid–size clinics gain enterprise–level billing tools without heavy IT overhead. Multi–Specialty Groups: Centralized revenue management across locations with role–based access controls. Billing Services: Third–party billers can handle larger claim volumes efficiently with automated workflows. Why ICONIC Pro Stands Out: Unlike siloed billing tools, ICONIC Pro integrates clearinghouse, analytics, and denial management in a single SaaS solution—eliminating multiple vendor contracts and disparate interfaces. Its cloud–native design delivers automatic updates and 99.9% uptime, backed by TKSoftware's responsive support team. About TKSoftware Inc.: TKSoftware Inc. is an Indiana–based technology company specializing in medical billing, practice management, and clearinghouse solutions. For over 25 years, TKSoftware has empowered healthcare providers with innovative, compliant, and user–friendly platforms that optimize revenue cycle performance and improve patient satisfaction. Learn More: Visit to schedule a demo and discover how ICONIC Pro can transform your practice's revenue cycle management. Contact:Tony Kurzendoerferinfo@ Photos: Press release distributed by PRLog View original content: SOURCE TKSoftware Inc. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
New York Times
21-06-2025
- Health
- New York Times
When an Eyelash Pluck Is Unexpectedly Billed as a Surgical Procedure
Q: During a routine visit to the eye doctor, he noticed an eyelash on my bottom eyelid appeared to be poking my eye and said he'd remove it. When the bill came, it was listed as 'surgery.' The ophthalmologist's office billed my insurer for $335, and the doctor's office said I owed them $200. Is this possible — what are my rights? — Reese Morgenstern, 28, Los Angeles A: As with buying a car, paying college tuition, and yes, health care, customers rarely pay the sticker price. The true price you end up paying becomes a game, and it's up to you to figure it out. Will you have the endurance to make all the requisite calls? Will you relent and just pay what you're told? Who will win? Capitalism! In this case, Mr. Morgenstern wanted to understand how a regular eye checkup — albeit, one inside the behemoth University of California, Los Angeles health system — and a casual mention of a wayward eyelash could cost hundreds of dollars out of pocket. The office was in network. His co-payment was $30. Was there any way out of a charge within a health care system where dabs of skin glue cost more than $1,500 and high-tech bandages can reach millions? Here's how it happened: The doctor, kind and pleasant, noticed Mr. Morgenstern had a stray lash grazing his eye and said he'd remove it. 'OK,' Mr. Morgenstern said. Using what Mr. Morgenstern said looked like a pair of drugstore tweezers, the doctor plucked the lash. He left shortly after. Tell us about your financial dilemma. Want all of The Times? Subscribe.
CNA
20-06-2025
- Business
- CNA
Mount Elizabeth hospitals not always most expensive among private providers, CNA finds
SINGAPORE: Despite its reputation for premium pricing, Mount Elizabeth hospitals do not consistently charge the highest fees among private healthcare providers in Singapore, a CNA review of medical billing data has found. Based on typical bills for 10 common medical procedures listed on the Ministry of Health's (MOH) cost comparison portal, Mount Elizabeth topped the list in only three cases. The "typical bill" refers to the median cost paid by patients in 2023. While Mount Alvernia Hospital was found to be cheaper in some instances, it was excluded from CNA's comparison as it operates as a not-for-profit institution. In the three cases where Mount Elizabeth was most expensive, Mount Elizabeth Novena charged 5.1 per cent more for a knee arthroscopy, 11.3 per cent more for hernia repair and 38.2 per cent more for an appendicectomy compared with the next-most expensive private hospital option. However, the same data showed that Mount Elizabeth is not always the costliest option. For example, fibreoptic colonoscopy day surgery and iridectomy at Mount Elizabeth Orchard and Novena were cheaper than at other private hospitals. Insurer Great Eastern announced on Tuesday (Jun 17) that it has stopped issuing pre-authorisation certificates for policyholders admitted to the two Mount Elizabeth hospitals. Such certificates are still available for other hospitals and day surgery centres, it said. Pre-authorisation refers to the insurer's approval of coverage for medical costs before treatment. 'In the last few years, we have observed that certain private hospitals have been charging significantly more than others for the same treatment, same clinical outcome, similar level of complexity, as well as for procedures that are less complex," the insurer said on Thursday in response to CNA's queries. "The cost difference in total bill size typically ranges between 20 and 30 per cent but can sometimes go higher in some cases.' Based on MOH data, the typical inpatient bill for a knee arthroscopy – a surgical procedure to diagnose problems within the knee joint – at Mount Elizabeth Novena was S$22,559 (US$17,560) and S$22,208 at Mount Elizabeth Orchard. It was cheaper at Gleneagles Hospital, which charged S$21,456. For an appendicectomy – removal of the appendix – Mount Elizabeth Novena charged S$30,808, compared with S$22,297 at Raffles Hospital, while for hernia repair, Mount Elizabeth Novena charged S$35,944, higher than the S$32,288 charged by Gleneagles. In contrast, iridectomy, a surgical procedure primarily to treat glaucoma, was cheaper at Mount Elizabeth Orchard (S$2,367) and Mount Elizabeth Novena (S$2,602) compared with Farrer Park (S$3,874). Beyond MOH's data, CNA reviewed itemised hospital bills from Mount Elizabeth Orchard, Parkway East and Gleneagles over the past two years. While Mount Elizabeth charged marginally more for common items such as hygiene sheets and lignocaine injections (1.7 to 7.7 per cent higher), it charged less for other items, such as ECG electrodes. Mount Elizabeth Orchard and Novena are operated by IHH Healthcare Singapore, the country's largest private healthcare provider. Other hospitals under its umbrella – including Gleneagles and Parkway East – are not affected by Great Eastern's pre-authorisation suspension. CNA contacted IHH and Great Eastern for comment on the pricing differences. In response, IHH said that comparing the typical bill sizes across hospitals and interpreting them at 'face value' is 'overly simplistic' and 'misleading' in reflecting each hospital's value and affordability. 'The Table of Surgical Procedures is a ranked listing of procedures that focuses on the intent and outcome of the surgical procedure. It does not reflect the surgical access route or the technologies, facilities and equipment used. Neither does it reflect the expertise and skill of the healthcare practitioners involved,' an IHH spokesperson said. The spokesperson also said that the two Mount Elizabeth hospitals, due to their level of 'equipping and capabilities', tend to take in more complex cases across all specialties, as doctors also make 'active choices' on where to admit patients based on the patient's best clinical interests. 'It is therefore natural that the average bill sizes seen at these two hospitals be higher compared to other facilities,' the spokesperson added. Great Eastern referred CNA to its previous statement. Great Eastern said earlier that the move is part of its efforts to manage rising healthcare costs and ensure affordability for its policyholders. "We want to assure our policyholders that there is no change to their coverage, and they can still receive treatment and submit claims as usual with no impact to their benefits," a spokesperson added. The IHH spokesperson said that their analysis of publicly available data from MOH does not correspond to Great Eastern's claims that bills at Mount Elizabeth hospitals are 20 to 30 per cent higher. They added that they have formally written to the insurer and are 'awaiting their response'. IHH previously expressed "surprise" at Great Eastern's move, saying it has been in active discussion with the insurer over the past few months. 'We do not agree with GE's claim about higher prices at two of our hospitals for similar procedures and case profiles," its group COO and Mount Elizabeth CEO Yong Yih Ming said on Wednesday. "Each of our hospitals has different focus and areas of excellence - Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital house facilities and equipment that allow specialists to manage patients and perform surgeries that are not available at other hospitals.' This is also why some of the more complex cases are managed at these two hospitals, he said. In response to media queries, MOH said on Thursday it is engaging Great Eastern to better understand the implications of its decision. Integrated shield plans (IPs) are commercial products, the ministry said. While MOH regulates the key parameters of these products for financial sustainability, insurers retain discretion over administrative processes like pre-authorisation. "However, IP insurers would have to ensure that policyholders continue to be able to access the full benefits of their policies in accordance with the terms and conditions for claims, as stated in their policy contracts," it added. MARKET DYNAMICS, COST STRUCTURE DRIVE PRICING VARIATION Experts told CNA that pricing differences across private hospitals are influenced by a range of factors, including the time and resources required and the hospital facilities used. 'Public hospital fees are subsidised by the government and are structured to ensure patient affordability. In contrast, private hospitals operate independently and need to factor in staffing, overheads, service-level costs and profitability when setting prices,' said Mr Joshua Siow, who is a partner at Simon-Kucher and its head of healthcare and life sciences in Singapore. For example, in the case of different drug prices, public hospitals rely on a centralised procurement system, which helps standardise prices across institutions, said Ms Verlene Law of The Reg Consultants, a regulatory service provider specialising in pharmaceutical and medical companies. Private hospitals procure drugs independently and prices can differ based on their supplier agreements and business models, she said. Private hospitals may also serve different patient segments or offer specialised clinical services that justify higher fees, said Mr Siow. "Patient experience, hospital infrastructure and differing target customer segments can contribute to variation," he said. "Importantly, some institutions may be equipped with specialised equipment or specialist capabilities that may not be routinely available at other centres.' He added: 'As for-profit institutions, private hospitals in Singapore operate independently and serve varied patient segments. In this context, pricing is shaped less by regulation and more by consumer choice – patients can select their providers, and hospitals must remain reasonably price-competitive to sustain demand.'
