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 Jason Anderson | Oct 3, 2018 | Healthcare Appeals, Healthcare Reimbursement, Hospital Reimbursement, Hospital Revenue Cycle
When Maryland hospitals attempt to discharge a fee-for-service Medicaid recipient to a lower level of care but are not able to, they may want to be reimbursed for “administrative days.” These are days of care for a patient who no longer needs acute inpatient care but...
by Chris Thibeault | Dec 3, 2015 | Appeals and Denials, Healthcare Appeals, Healthcare Reimbursement, Healthcare Updates, Hospital Reimbursement, Hospital Revenue Cycle
Medicare’s Consolidated Billing Rules for Home Health Beneficiaries Apply to Hospital Claims. In reviewing denied claims referred to our office, it is my experience that hospitals must be aware of Medicare’s Consolidated Billing rules when providing services to home...
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 | Aug 25, 2015 | Healthcare Reimbursement, Healthcare Updates, Hospital Reimbursement, Managed Care Reimbursement, Payer Reimbursement, Revenue Cycle Management
What would you tell health plans if you had the chance to talk to them in person? Typically, participating agreements between healthcare providers and payers include requirements for a Joint Operating Committee (JOC) meeting, as an opportunity to address and resolve...
