Melinna has developed innovative solutions to broaden access to effective healthcare since 1996. In 1996, Melinna patented a method and system for determining the cost and legality of treatment procedures delivered by licensed health professionals whose services were not previously coded. This patented system currently monitors over 18 million legal and training references to coded procedures delivered by over 2 million health professionals (non-physicians and alternative medicine providers). This system was designed to validate the legality of their care as claims are filed as a practical means to reduce Fraud and Abuse while expanding access to quality care provided by qualified professionals.
Prior to founding the Company, Melinna designed health plan benefits for large employers who self-fund a portion of their employees’ healthcare benefits. Her experience included monitoring outcomes, negotiating with managed care organizations, securing third party administrators and shopping for reinsurance.
Melinna also designed and managed the development of ABC codes. ABC codes are used to supplement medical procedure codes (CPT and HCPCS II) as claims are filed. Her company partners with Relative Value Studies, Inc. to provide relative value units (RVUs) for ABC codes. ABC codes paired with RVUs enable managed care contracting, automated reimbursement, financial outcomes analysis and comparative effectiveness research.
From 2008 to 2010, Melinna also led in the design of a prototype online claim filing system which established that ABC codes and legal logic could be added to standard electronic claims filing systems. She continues to monitor standard healthcare transactions and regulations that impact non-physician and alternative medicine billing.
Melinna has testified before health-related government committees, written articles for leading healthcare publications and has designed continuing medical education courses for health professionals. To view a presentation she gave to the National Press Club, please click here.
Consulting services include:
• Business and technical solutions to streamline provider and payer connectivity
• Regulatory challenges and mitigation within standards setting organizations and government oversight committees
• Healthcare electronic data interchange (EDI) challenges and solutions
• Medical cost benchmarks and measuring cost effective options to conventional medicine
• Potential risks related to HIPAA Fraud and Abuse and risk mitigation
• Addressing ineffective business processes and reducing administrative costs.
Direct Line: 505-503-1336
References available upon execution of Non-disclosure Agreement.
Tim Bolen is a crisis management consultant specializing in identifying and overcoming problems facing cutting-edge health professionals. His company, JuriMed – Public Relations & Research Group, offers strategies for health professionals whose practices have come under attack by state or federal agencies.
Tim Bolen is also a consumer advocate and publishes the popular newsletter, “Millions of Health Freedom Fighters.” Tim’s newsletter has provided strong, humorous and sometimes scathingly sarcastic opinions about policies and people who are detractors of the American health freedom movement. Tim also promotes solutions to health policy problems and has successfully marshaled public opinion in support of these solutions for decades. He can be reached at email@example.com or at firstname.lastname@example.org.
Rhonda Bradford CEO, President and Owner of California Specialized Billing, Inc. since 1998. Rhonda has worked in the medical field since the 1970s. After 16 years working for Fountain Valley Regional Hospital, she transferred to the Medical Insurance division of the facility and spent 4 years learning and processing insurance claims and authorizations for the hospital IPA groups where she specialized in finding lost revenue in the claims being handled thru the IPA’s for the California Children’s Services. During that time she also developed a database to capture information related to independent nursing claims. Rhonda transferred to LA Care of Los Angeles where she developed a database for a pilot project funded by the State of California for California Children’s Services. When the project ended in 1998, Rhonda founded California Specialized Billing, Inc. Her company provides medical and non-medical billing for practices and physicians in a variety of healthcare specialties.