The Rising Need for Professional Medical Billing Services: An Analysis of the Cigna Lawsuit

Office Team

The medical billing landscape is complex and fraught with numerous challenges. A recent federal lawsuit against health insurance giant, Cigna, has brought a crucial aspect of this industry to the forefront: the integrity and thoroughness of claim processing.

Read about the Cigna lawsuit HERE

The class-action lawsuit, filed in federal court in Sacramento, accuses Cigna of utilizing an algorithm named PXDX to auto-reject hundreds of thousands of patient claims without individually examining them. This potentially violates California law, which requires a “thorough, fair, and objective” investigation of medical expense bills.

While Cigna defends the system, arguing that it expedites payment to physicians and ensures correct code submissions, the ramifications for patients and their care providers are significant. Countless patients are left without coverage, burdened with unexpected bills, and doctors have to deal with denied claims, even when the required procedures are medically necessary.

This situation illustrates why it is more vital than ever for medical practices to consider professional billing services such as those provided by MD Pro Solutions. With over 20 years of experience in the medical administration and billing industry, we understand the intricacies of the medical billing process, ensuring a comprehensive, individualized approach to each claim.

Our dedicated team scrutinizes claim submissions to prevent errors that could lead to unnecessary rejections. As part of our medical billing management service, we handle payment posting, denial management, and patient billing, among others. Our aim is to ensure seamless revenue flow for medical practices while adhering to all regulatory requirements.

Moreover, at MD Pro Solutions, we believe in the power of human touch. While we leverage advanced technologies for efficiency, we do not solely rely on them for decision-making. Our certified coders and expert administrators are actively involved in each step of the process. This ensures every claim receives the attention it deserves, mitigating the risk of automated, indiscriminate denials.

Furthermore, MD Pro Solutions offers a specialized service for accounts that are 42 days past due, ensuring that medical practices can focus on patient care while we take care of their financial health.

The Cigna lawsuit highlights a challenging reality of the medical billing industry, one that can be addressed with professional, experienced intervention. By entrusting your billing to MD Pro Solutions, you not only maximize your practice’s revenue but also safeguard your patients’ rights to coverage. Now more than ever, our services are not just a convenience – they’re a necessity.

Call us at 508-946-1665 if you have any questions regarding MD Pro Solutions’s educational and training opportunities. If you have any queries regarding our ENT billing and coding software, we are happy to address them, conduct a thorough examination, or arrange for an independent CPA audit. If you’d like to discuss how to enhance account management at your Otolaryngology clinic or practice, please give us a call.