by Philip Wright | Aug 3, 2018 | General Litigation, Insurance Coverage Disputes
Given the aging infrastructure in Maryland, water pipe bursts like these are occurring more often. And they can cause major headaches. Besides disrupting traffic, they often damage nearby property and interrupt business operations. So who foots the bill when a burst...
by Gustavo Matheus | Jul 2, 2018 | Healthcare Appeals, Healthcare Reimbursement, Insurance Coverage Disputes
When Healthcare Services that are not Medically Necessary can be Reimbursed. Providers that know this one exception to the rule are less likely to leave money on the table. A mainstay of managed care is that coverage applies only to medically necessary services....
by Gustavo Matheus | May 24, 2018 | Healthcare Appeals, Insurance Coverage Disputes
How healthcare providers can avoid getting tripped up by the medical necessity requirement. The world of medical claims is littered with booby traps that can catch providers off guard. Our law practice has found that healthcare service providers often get tripped up...
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 Melissa Townsend | Dec 9, 2016 | Insurance Coverage Disputes, Workers Compensation Litigation
The “Going and Coming Rule” in Maryland As any parent with small children knows, important messages are sometimes best simplified in stories involving well-known characters. Here is a story with an important message: As the seven dwarfs commuted home from work one...
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...
