News & Events

Author Archive

Common Medical Billing Mistakes That Affect Customer Service (and How You Can Fix Them)

No one likes receiving medical bills, because they often contain unwelcome surprises. If your billing department receives frequent phone calls for overbilling, your practice might be guilty of one – or more – of these behaviors that lead to customer dissatisfaction and decreased billing productivity. Medical claims processing is a critical part of a practice, and claims processing software can help keep patients happy and ensure there are no delays in clearing the medical billing clearinghouse. Make your billing department run smoothly by avoiding these mistakes.

How Big a Problem Are Medical Errors?

The Department of Health and Human Services estimates that 42 percent of medical bills sent to Medicare in 2010 contained errors. These errors resulted in a staggering cost of $6.7 billion. Assuming this is representative of medical claims in general, this means a sobering number of medical claims contain errors of some kind. In fact, Pat Palmer, the founder of Medical Recovery Services in Salem, Virginia, estimates that eight out of the 10 medical bills they review contain errors.

Medical billing software makes it easier to process medical bills accurately and can make it easier to catch errors before they leave the office. However, there is always some possibility of user error in the system. As long as humans are involved in the medical billing process, there will be errors. The goal is to reduce the errors as much as possible to avoid giving patients the impression that your practice is less than professional or even intentionally attempting to overbill them.

And while you may never hear a patient complain about errors that result in underbilling, these can occur frequently as well. While this may seem less of a problem from a customer service standpoint, undercoding, or intentionally coding to avoid charging patients for all procedures, is illegal in many cases and can result in many problems for your office. Coding medical bills accurately is vitally important to improve patient customer service and avoid the problems of overcharging and underbilling.

Balance Billing

Balance billing is one of those tricky areas that can get an office in trouble for billing incorrectly and can make patients extremely irate. Balance billing is the process of billing a customer for health care costs over and above their deductible, coinsurance, or copayment and the amount the insurer is obligated to pay. When a balance remains after these payments, a problem can arise if the patient is billed for it.

In many cases, balance billing is illegal. If the patient is on Medicare or Medicaid and the provider has an agreement with these programs to accept the Medicare- or Medicaid-negotiated rate, balance billing is forbidden by the agreement and is illegal. In the same way, if a provider has a negotiated contract with an insurance provider to accept a certain payment structure, balance billing over and above that negotiated payment is illegal.

However, an office may often see patients for whom balance billing is not illegal. When a patient sees an out-of- network provider, that office may have no negotiated contract price for procedures. In this case, the amount the insurance company is obligated to pay after the patient deductible and copayments are met may be less than the amount the provider charges for the procedure. In such a case, the provider is perfectly within its rights to bill the patient for the balance.

The difficulty can arise when you have a mix of patients and balance billing is illegal for some and perfectly acceptable for others. In these cases, it becomes extremely important for the medical biller to make certain that a patient is properly billed in each case. Researching their insurance coverage and any agreements with insurance carriers is important to avoid balance billing errors.


While it is a simple matter to transpose letters or numbers or misspell names of patients or addresses, a simple typo is enough to get a claim rejected by an insurance company, often resulting in large bills being passed to the patient. The hardship created by these situations is enough to make any patient’s blood boil and should be carefully avoided.

Double check all spelling and numbers for patients’ names, addresses, and Social Security numbers, as well as all information for the insurance provider including policy number, address, and contact information. Medical billing software can help avoid these errors for provider and insurance company information, but entering new patient information should be carefully checked for any possible errors before billing.

Duplicate Billing

Duplicates are common mistakes that can haunt a medical billing department. A doctor and a nurse can both order the same treatment. In such cases, it is easy for duplicate billing to occur for a single procedure. Few errors will trigger a patient’s anger as quickly as duplicate billing. Most patients take it for granted that the mistake was intentional and will react accordingly.

While there is no easy way to explain such an error to a patient, catching duplicate errors only requires some extra care in double-checking the billing before it is sent to the patient and medical billing clearinghouse. Any entry that appears to be a duplicate should be investigated and confirmed before any bill is sent from the office.

Failing to Verify Patient Insurance Coverage

Patients’ health insurance can vary drastically from case to case. Even for a single patient, insurance coverage can change, oftentimes without the patient knowing that a change occurred. Failing to verify the patient’s insurance coverage can result in a large bill being sent to a patient who was not expecting one. Surprise medical bills are one of the least welcome events in a patient’s life and make your practice look bad, as the patient will blame you for not verifying the coverage beforehand.

Verifying patients’ insurance coverage is a key step in the billing process. Don’t skip this step. Always verify a patient’s insurance coverage before treatment to avoid having insurance claims denied and saddling patients with expensive bills.

Avoiding these common medical billing errors takes time and attention to detail, and most patients never notice when their bills are correct year after year. However, one error can lead to patient dissatisfaction and rejected claims. Take care to avoid these errors and keep your billing running smoothly.

Sources: errors/ billing-errors/ spot-mistakes- medical-bills/

Posted in: Medical Claims

Leave a Comment (0) →

ICD Coding and Billing Tips with No Official Diagnosis

There are many reasons that a patient might report to a physician and leave the office without a diagnosis – maybe the symptoms are nonspecific, or maybe the patient requires a referral to a specialist better suited to make the correct diagnosis. No matter what the reason, coding and billing these cases can be pretty tricky. Medical claims processing is often a complicated and difficult task, and when no diagnosis is reached, properly coding these cases presents a unique challenge.

Coding a claim incorrectly can be costly for both your practice and for the patient. Few things lead to irate patients faster than an error in billing. And if you have the claim coded wrong in your medical billing software in such a way that it undercharges an insurance company, you are sure to encounter a great deal of difficulty in correcting the error after it has cleared the medical billing clearinghouse.

Accuracy in these challenging cases then becomes a high priority for you, your patients, and the insurance company. However, with care you can avoid incorrect codes and ensure your treatment and billing are seamlessly integrated. Putting in the extra time to research individual cases can often result in better care for patients and more accurate payments. Here are some tips for ensuring that your billing is accurate for these cases.

Common Circumstances Where No Diagnosis May Be Reached

There are several circumstances that may arise for a doctor/patient visit that does not result in a diagnosis being reached. For many of these circumstances, there are clear guidelines for medical claims processing on how to code and bill for these services.

Preventive care services are often covered by a patient’s insurance and can be billed under the appropriate code for the visit. These can include instances where the patient is being evaluated due to a personal history that makes a disease more likely in their case. In other cases, you may have a patient with a family history of a disease, for example, a female patient with a history of breast cancer in her family. These claims should be verified with the insurance company to ensure they are covered, but are routine in nature and should be covered by your medical billing software.

Other patients may come in for certain screenings or for prophylactic services. Typically, these screenings may not involve ultimately coming to a diagnosis of a problem, but are useful in ruling out current or future health issues. These are covered under many patients’ medical insurance plans. Check with the insurance provider to verify the benefits and process these claims under preventive health codes.

In many cases, a patient may return for a follow-up exam after a previous injury or illness has been treated. For these claims, there is no current diagnosis, nor should the claim be filed under the previous diagnosis, as that no longer applies.

However, there are codes relating to follow-up visits. Coding follow-up visits improperly is a common source of errors and should be very handled carefully. Many times, the follow-up is incorrectly billed as part of the original diagnosis rather than billed as a follow-up visit. This often results in overcharging the patient and insurance company for the visit, and may even have the claim denied under inappropriate billing codes. Be sure to use the proper follow-up visit codes to avoid this error.

Cases Where an Ill Patient Does Not Receive a Diagnosis

In many cases, patients come in with symptoms that prompt them to seek medical treatment, yet the physician can make no diagnosis. These cases often result in errors in medical billing coding due to confusion about how to handle the situation. However, in every case, a method exists for proper coding and billing for treatment.

In many cases, where a diagnosis is not immediately able to be made, the physician may observe and wait as a strategy. The patient is directed to follow a course of treatment, e.g., rest, intake of liquids, etc., and return after a specified period. In many cases, the symptoms were transient and disappear before any diagnosis can be made. In this case, the symptoms themselves are listed in the coding for the billing.

In other cases, the symptoms may not immediately lend themselves to a diagnosis; however, rather than returning for a follow-up visit, the patient may elect to find a different physician or may never return for whatever reason. In this case, no diagnosis can be made and so once again the symptoms presented are instead listed as the codes used in medical billing software.

Finally, there are some cases where, even after repeated exams and treatment, defy diagnosis, and a physician may be forced to simply attempt to treat the symptoms or provide palliative care. Here, the patient may return for treatment multiple times, and yet no diagnosis is ever reached. In these cases, once again, the symptoms presented are listed for the coding and billing.

It should be noted that in most cases, listing symptoms in the medical coding where there is a diagnosis is not appropriate. If the symptoms are integral to the diagnosis, the symptom should not be separately listed. If the symptom is not part of the diagnosis, it may be listed as part of the history of diagnosis to better explain how the diagnosis was reached, or what obstacles led to difficulties in achieving a diagnosis. In all other cases, unless a symptom is required to be listed by the classification, the symptom should not be listed.

Avoiding Overbilling for Nonspecific Conditions

ICD-10 guidelines offer clear specifications on billing codes even when a nonspecific condition presents itself and no diagnosis is forthcoming. While the process of arriving at the correct code may be confusing, getting the coding correct will lead to accurate billing, which translates into timelier payments, happier patients, and avoidance of underpayments. As such, every effort should be made to research and apply the appropriate codes, even in cases where the physician cannot make a diagnosis.

Sources: billing-errors/ 10-cm- coding-tips- signs-and- symptoms/ Coordination/Fraud-Prevention/Medicaid- Integrity-
Education/Downloads/docmatters-presentation- handout.pdf

Posted in: Medical Claims

Leave a Comment (0) →

Why Surprise Medical Billing Is a National Problem

Is Federal Action Needed to Stop Surprise Medical Bills?


There is a national crisis brewing in medical claims processing, but the federal government has yet to intervene. Surprise medical billing occurs when a patient gets a bill from an out-of-network provider, despite receiving treatment from a facility that’s within a patient’s health care plan. The provider, which is usually employed by a third party, holds the patient responsible for charges that the insurer won’t cover.


The corrupt practice occurs in every state, but only one has been actively keeping track of it and taking measures to stop it. Texas has been more progressive than most in helping patients fight the practice of balance billing.


This is an issue that has taken hold across the United States, but is especially common in Texas. Advocates from both sides of the aisle have been pushing for better regulations, but providers, insurers, and business groups all disagree about how to handle it.


Texas has allowed patients strapped with high bills to fight charges through mediation provided by the Texas Department of Insurance. This requires the insurer and provider to work together to come up with a fair payment. In the 2015, the program expanded to allow any citizen strapped with a “surprise bill” of over $500 to enter mediation. The insured person remains off the hook until the insurer and provider can come up with a suitable arrangement.


While these measures are an important first step, it’s not a step that’s available to all patients struggling with balance billing. The mediation process now only applies to those who have a major-medical preferred provider organization health plan. By virtue, this excludes self-funded, retirement, government-run programs, and HMOs. A bill introduced in the Texas Senate, however, aims to change that.


Sen. Kelly Hancock, R-North Richland Hills, recently introduced a bill in the Texas Senate that includes all kinds of out-of-network providers, including facilities such as freestanding emergency centers. It would also require providers to disclose the fact that balance bills might be eligible for mediation.


A National Crisis?


The Affordable Care Act provides some recourse for individuals who must seek emergency care in out-of-network hospitals. If an insurer would cover 80% of costs for out-of-network care, for example, they must do the same in an emergency room. There is nothing, however, that says that a hospital can’t mark up the cost of care to exceed what an insurer reimburses.


The problem is particularly prolific in emergency rooms, with a recent study in the New England Journal of Medicine citing that balance billing occurs in around 22% of all emergency room visits. Another study from the Federal Trade Commission came to a similar conclusion.


Patients in need of emergency care have no choice in determining what is in or out of network; the ambulance decides where to take the patient. In some cases, the ambulance itself might be out of network. A common story is that someone is injured, and an ambulance is called. Though the injured person has insurance for the treatment, it may not cover the ambulance ride, which can be in the thousands.


“In-Network” Balance Billing


Even if you seek care from an emergency facility, you may receive a balance bill because a specialist is out-of-network. Specialists like anesthesiologists, pathologists, and even surgeons may be out-of-network because they work for a third-party company. Hospitals may hire specialists on a contract basis, because it saves money on malpractice premiums and helps shield them from liability. This makes medical claims processing a nightmare and saddles patients with astronomical bills they weren’t expecting.


How Much Does Surprise Billing Cost?


In a realistic scenario like routine surgery, emergency care for a broken limb, or a complicated delivery, a patient could receive a balance of tens of thousands of dollars or more – even when insured. An article in the New York Times reported that a non-network surgeon, who only assisted in a neck surgery, charged $117,000 for services, over 20 times what the lead surgeon charged (in-network). The same investigative report found that plastic surgeons charged $250,000 following stiches for back surgery, and the insurer only paid $10,000, leaving the patient to pay for the rest.


This practice can have a trickle-down effect on American taxpayers, especially when considering the lack of protection for government-run programs like Medicaid and Medicare. Balance billing is a practice that requires federal intervention.


Possible Solutions to Balance Billing


There are currently a few federal actions that could offer a degree of protection from surprise bills. They run the gamut from require that any portion of the bill go towards a patient’s out-of-pocket maximum to holding the patient not responsible for any in-network costs. Some of the propositions include:


  • The 2018 ACA Benefit and Payment Parameter Rule. This prevents health care plans from charging people any more that their in-network amounts for emergency care. It also requires that surprise bills count toward the out-of-pocket maximum, which is important because nearly half of silver plans on the marketplace do not have out-of-pocket limits for out-of-network care.
  • The End Surprise Billing Act. This bill aims to end bills for patients who receive treatment at an in-network hospital. Under the provision, patients would be financially harmless for out of network charges above their typical in-network costs. Additionally, the bill addresses the need for a notification and consent process in which patients acknowledge they’re receiving treatment from an out-of-network provider.


It’s important to note that there are certain situation in which balance billing goes against federal guidelines. For payers of last resort like Medicaid and Medicare, for example, balance billing might not be allowed. Medical billing software or claims processing software can help your practice remain compliant concerning these issues.


Balance billing is becoming a national crisis. Without federal intervention, bills will continue to increase, and the excess will be passed on the American taxpayer. There are proposed solutions to address the problem, but we must do more to effectively control the costs of health care and ensure everyone has access to quality care.



Posted in: Insurance Claims

Leave a Comment (0) →

Marijuana Medical Claims Processing and the FDA

What the FDA Says About Marijuana Claims


When California becomes the eighth state to legalize recreational marijuana in 2018, the pressure will be high for the Food and Drug Administration to start enforcing some regulatory practices – despite its use being a federal crime. More states around the nation are expected to approve cannabis for recreational and medicinal use, which will likely transform medical claims processing for marijuana pharmacies.


Though many users and doctors who prescribe medical marijuana are concerned about the FDA’s interference, it may be good news when it comes to getting insurance to cover such treatments. Though most of these dispensaries are trustworthy, as with any industry, some bad apples are making processing these claims difficult.


What Are the False Claims Regarding Marijuana?


Most doctors and dispensaries that sell medical marijuana explain to patients that the plant can help many symptoms of diseases from glaucoma to epilepsy. However, there are a few who claim cannabis is a cure-all – some even suggesting it will cure cancer. The FDA is warning consumers about four companies who sell marijuana-derived dietary supplements, gummies, lotions, and oils – all of which claim their products cure cancer. Dr. Scott Gottlieb, the FDA’s commissioner and a cancer survivor himself, wants to make it clear that these are scams.


How the Scam Works


The active ingredient in many of these supplements in cannabidiol, a derivative of marijuana that is not approved by the FDA for any use, medicinal or otherwise. These companies sell supplements over the internet as creams, lotions, oil drops, teas, and more. Many of the websites feature “endorsements” by people who claim they themselves or their loved ones have been miraculously cured of illnesses. Gottlieb points to the obvious danger of these testimonials –when people rely on untested treatments for serious illnesses, they may not seek proven methods of treatment, treatments that could mean the difference between life and death in some cases.


These dispensaries – Green Roads of Florida, Stanley Brothers Social Enterprises, Natural Alchemist, and That’s Natural – each claim their products cure cancer, reverse Alzheimer’s disease, and stop other terminal diseases. It’s because of places like these that medical claims processing for insured marijuana users gets tricky.


The FDA dispensed warning letters to these companies, and many of the websites’ claims to cure cancer have been removed, but, without FDA regulation, it’s impossible to tell the good marijuana pharmacies from the bad. With the promise of regulatory compliance, perhaps these bloated claims will diminish.


Are There Medicinal Benefits to Marijuana?


Though cannabis has been used for medicinal purposes for millennia, possessing and using cannabis is still a violation of federal law, with the exception of research settings. A growing number of states and territories, including the District of Columbia, have approved measures that allow its medical use.


The FDA has not approved marijuana for treatment of any cancer or illness. However, cannabinoids produce a pharmacologic effect by activating certain receptions in the central nervous system and immune system. Because of this, the FDA has approved the use of commercially available cannabinoids, like nabilone and dronabinol, to treat some cancerous side effects. Long known to help ease the pain of cancer treatment, marijuana is now being studied for its effect on malignant tumors. However, there’s been no proof that marijuana changes the affects cancerous cells – only that it can ease the symptoms of cancer-sufferers.


Review of the Literature


There is a growing body of evidence that investigates the link between cannabis, cannabinoids, and possible benefits in treating cancer’s side effects. There have been several controlled clinical trials and a subsequent meta-analysis of these trials found that dronabinol and nabilone have a beneficial effect on chemotherapy-induced nausea and vomiting. The FDA approves these two cannabinoids for both the prevention and treatment for vomiting, but not any other symptom management in cancer patients.


There have also been clinical trials regarding the use of inhaled cannabis in cancer patients. Based on these studies, there is insufficient evidence to suggest that cannabis has a similar positive benefit to those suffering with chemotherapy-induced nausea and vomiting.


A common side effect of chemotherapy and cancer in general is pain. In light of the opioid crisis, practitioners are seeking alternatives to address the painful side effects of cancer and its treatment. A growing number of trials are focusing on the oromucousal (mouth mucous membranes) administration of cannabis extract. National drug regulatory agencies in some European countries and Canada approve this formulation for pain control in cancer patients. The FDA has yet to follow suit, citing a lack of robust evidence.


Can Marijuana Treatments Be Harmful?


There’s no doubt that cannabis and cannabinoids have been beneficial in controlling chemotherapy’s side effects and improving appetite in those with illnesses such as HIV. In some animal studies, cannabinoids have slowed the growth of certain types of cancer cells, but human studies have not shown any positive benefit. As suggested by Dr. Gottlieb, one of the biggest harms of extolling these claims is that it may cause a sick patient to rely on cannabis while delaying or avoiding convention medical treatments. This could have serious or even deadly consequences.


The Dangers of Unregulated Marijuana


It shouldn’t be ignored that marijuana isn’t always just cannabis. Smoking marijuana introduces other harmful substances to users, including some of the carcinogens founds in tobacco smoke. Because it’s unregulated, each plant comes with different levels of active compounds, and it might be created with other substances that can be dangerous to each user. The effects of these substances can be difficult to predict and varies from person. Aside from FDA-approved cannabinoids, there is no established safe dose.


The Future of Marijuana and Its Effect on Billing


Despite marijuana use being a federal crime, Gottlieb says it’s time for the FDA to act. With some states legalizing it for both recreational and medicinal use, some quality control standards should be instated. He emphasizes the need for intervention regarding companies that make grandiose claims that would steer people away from conventional evidence-based treatments. He also believes in broadening the scope of regulating cannabis and cannabinoids in general.


As of now, insurance companies are only accepting claims for cannabinoids dronabinol and nabilone, approved for use by the FDA. Better and more thorough regulation would mean more standardized billing processes, and insurers would likely be more willing to cover marijuana as a treatment – if it’s treating something it can help. Though states are legalizing it for medical use, many dispensaries still operate on a cash-only basis. The future of medical billing for marijuana will likely evolve, and, thankfully, medical billing software will evolve with it.



Posted in: Medical Claims Processing

Leave a Comment (0) →

Why Your Office Needs the Right Medical Claims Clearinghouse

You are diligent in making sure your medical claims are clean and correct before sending them to the payer. You have dependable medical billing software to help ensure casual mistakes caught early on. You may have heard medical claims clearinghouses benefit healthcare providers, but wonder what they might offer that you don’t already provide. Is it worth the additional expense or something your practice can do without? Here are some of the reasons your office can benefit from choosing a medical claims clearinghouse.

Records Are Increasingly Electronic

Most likely you still send paper bills, but healthcare claims are increasingly processed electronically. Instead of claims going through the post office, Medicare and many large insurance payers prefer to use electronic clearinghouses to sift through claims looking for errors and submit them through the proper channels.

Clearinghouses send and receive large amounts of medical billing and claim data, and each submission or action can trigger a separate response. Software manages the procedure so it happens quickly and correctly. Medical billing departments can view and manage claims during any stage of the process from one location.

Improve Current Processes

Right now, you probably receive medical claims as a superbill. Your staff transfers that information to your billing software, prints it as a CMS1500 form and mails it to each insurance company.

Once it arrives, the insurance company looks it over for errors. If they find any, they send it back to you and your medical billing staff has to start over. If the claim is clean, they submit their part of the payment and you move on to billing the patient for any remaining balance. The whole process takes a significant amount of time and manpower.

Often, the longer it takes to bill the patient, the less likely they are to pay. The more times data has to be handled and input, the greater the likelihood of making a mistake.

Prevent Billing Problems and Returned Claims

Most of the time, claims are rejected or denied because of human error. Insurance companies return rejected claims to billers because they contain one or more errors and need to be corrected. Clearinghouses use scrubbing to make sure claims are not rejected.

Denied claims are ones the insurance company has processed and found unpayable. Sometimes billers can appeal the decision, but if the bill is for procedures not included in the patient’s coverage, appeals will not be successful.

The U.S. Government Accountability Office gathered data on insurance denials and found that insurers denied coverage more often because of billing errors and eligibility questions than because they disagreed with the necessity for the care the patient received. Doctors and other healthcare providers lose an estimated $125 billion every year because of medical billing issues.

  • Clearinghouses evaluate bills to check for the following errors:
  • Missing or incorrect patient data – A single error in the patient’s name, gender, birthdate or insurance number can lead to claim rejection.
  • Erroneous insurance provider information – if the payer’s contact information or address contains flaws, insurance might return the claim.
  • Inaccurate billing codes – If the Place of Service codes, HCPCS or CPT codes have confusing modifiers attached or digits are missing or transposed. the claim might be sent back.

Healthcare providers have also had claims returned for mismatched medical codes, forgetting to include procedures or diagnoses or submitting more than one bill for the same service. Other errors like undercoding, poor documentation and upcoding are a type of fraud and will also trigger rejection.

Medical Claims Clearinghouses Improve ROI

When healthcare providers use a good medical billing clearinghouse, their return on investment (ROI) dramatically increases. Your organization gets paid faster, which gives you an advantage over the competition. Here are several ways a clearinghouse improves your profits:

  • Once your practice submits a claim, clearinghouse software scours every line to identify errors you might have made during data entry. They identify errors in seconds and let staff know right away, while they are still working on the file. Not only do you reduce wait time from days to seconds, your employees find out about the error while the information is still fresh.
  • A clearinghouse stores information on individual payers in their system, so that data doesn’t have to be entered every time. Instead of re-keying data for every claim, it is electronically filled in for you. Electronic submission makes claims easy for the insurance payer to access.
  • Send all your claims at once instead of having to submit a separate file for each payer. Faster submission reduces the time it takes before you’re paid.
  • Your practice likely backs up data, but in the event of a natural disaster or unforeseen emergency, your clearinghouse can provide you access to any medical billing data you submitted before it was lost.
  • Save money on printing, postage and envelopes and leverage the fact your business is environmentally responsible with your clients. As people grow more conscious of environmental care, point out you care for the planet with the same dedication you offer your patients.

Why Not Go Direct?

Medicaid, Medicare, BlueCross and other large payers allow you to electronically submit information to them directly. You may wonder why you should hire a medical claims clearinghouse instead of going that route.

Submitting claims directly requires going to each payer’s individual website and keying in transaction data. Billing staff has to navigate multiple websites, keep track of separate passwords and learn error codes that are specific to each payer. Data is spread out over numerous locations and harder to track. Some payers require you to purchase additional software and provide little or no technical support.

Your practice ends up with wasted time, frustrated staff, high number of errors and frequent denials. It’s electronic, but it’s inefficient.

Apex EDI offers a larger payer list than any other service of its type. Thousands of practices use our software because its OneTouch solution provides a simple, cost-effective way to submit claims and receive quick reimbursement. Contact us to see how we can help you make more money today.

Sources: clearinghouse-1794650 problems-returned- claims/

Posted in: Claims Clearinghouse

Leave a Comment (0) →
Page 1 of 32 12345...»