by Gustavo Matheus | Feb 25, 2014 | Healthcare Reimbursement, Managed Care - General, Medicaid Reimbursement
The Maryland Department of Health and Mental Hygiene has proposed a rule that significantly improves the dispute resolution process for healthcare providers appealing managed care organization (MCO) payment denials based on medical necessity grounds. Under the...
by Karen Kizer | Jan 28, 2014 | Appeals and Denials, Denied Claims Litigation, Healthcare Reimbursement
Solving the Problem of Utilization Review and Hospital Payment Denials Today’s health insurance plans—whether health maintenance organizations or traditional indemnity plans—must reimburse hospital, physician and other provider services only if they are deemed...
by Gustavo Matheus | Nov 26, 2013 | Hospital Revenue Cycle, Revenue Cycle Management
HEALTHCARE ANALYTICS: DATA THAT DELIVERS. At the same time hospitals and other healthcare providers prepare to comply with the Affordable Care Act, they have to deal with yet another sweeping new federal healthcare mandate: The American Reinvestment and Recovery Act...
by Gustavo Matheus | Oct 22, 2013 | Healthcare Reimbursement, Hospital Revenue Cycle, Managed Care - General
In today’s complex, rapidly changing healthcare environment, hospitals are facing enormous financial pressures and tight operating margins. For hospitals to stay in business, they must use every available tool to reduce costs, manage their relationships with health...
