by Gustavo Matheus | Jul 27, 2017 | Appeals and Denials, Healthcare Appeals, Provider Denials
Insurance standardized codes can cause confusion for healthcare providers. In 2008, Medicare updated its policy to require contractors to employ standardize codes in paper and electronic Remittance Advice (RA) forms. Derived from Health Insurance Portability and...
by Gustavo Matheus | Oct 12, 2016 | Healthcare Reimbursement
Payers of healthcare providers’ claims demand documentation in support of air ambulance services – emergency room staff must consider risk of denial. Most healthcare practitioners are aware that hospital emergency departments are required by EMTALA to treat those...
by Gustavo Matheus | Apr 29, 2016 | Healthcare Reimbursement, Interpleader Action Defenses
Healthcare providers must promptly assert billing rights in personal injury cases before patient resolves personal injury claim From the time a patient who has suffered personal injuries is treated in the hospital’s emergency room, the facility, physicians, and...
by Gustavo Matheus | Mar 30, 2016 | Appeals and Denials, Healthcare Appeals, Healthcare Reimbursement
Solving the Problem of Utilization Review and Hospital Payment Denials by Karen Kizer, Senior Paralegal – Gustavo Matheus, Esq., LLC Today’s health insurance plans—whether health maintenance organizations or traditional indemnity plans—must reimburse hospital,...
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:...
