by Jason Anderson | Jul 21, 2020 | Denied Claim Appeals, Denied Claims Litigation, General Litigation, Healthcare Reimbursement, Hospital Reimbursement, Managed Care - General, Managed Care Reimbursement, Medicaid Reimbursement
Why litigation may be the best option in Maryland to recover denied claims Since its inception in 1997, Maryland’s HealthChoice program has expanded to provide healthcare coverage to a majority of Maryland’s Medical Assistance (“Medicaid) recipients. Through its...
by Gustavo Matheus | Aug 1, 2019 | Appeals and Denials, Denied Claim Appeals, Denied Claims Litigation, Healthcare Appeals, Healthcare Reimbursement, Hospital Reimbursement, Managed Care - General, Managed Care Reimbursement, Payer Reimbursement, Provider Denials
Utilization management requirements often run counter to the medical standard of care When representing providers, I have noticed an unfortunate trend in recent years. Utilization management (UM) is encroaching upon the profession of medicine. With utilization...
by Gustavo Matheus | Oct 29, 2015 | Appeals and Denials, Denied Claim Appeals, Healthcare Appeals, Healthcare Reimbursement, Healthcare Updates, Hospital Reimbursement, Provider Denials
Timely appeals help preserve rights of healthcare providers. The signed agreements between healthcare providers and managed care plans regulate the terms of the parties’ business relationship. These terms, often detailed in the payer’s provider manual, seem simple:...
by Gustavo Matheus | Jul 22, 2014 | Denied Claim Appeals
In contract law, disproportionate forfeiture – paying nothing if a service is not completed precisely as agreed under the contract – is considered a penalty because of its failure to take into account the percentage of work completed. Disproportionate forfeiture and...
by Gustavo Matheus | Mar 25, 2014 | Appeals and Denials, Denied Claim Appeals
Often contained in payers’ participating provider agreements (PPAs) and provider manuals are criteria for accepting or rejecting medical claims. The problem for providers, leading to numerous legal disputes over denied claims, is that nowhere in the published care...
