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 | Sep 29, 2015 | Appeals and Denials, Healthcare Reimbursement, Healthcare Updates, Managed Care Reimbursement, Payer Reimbursement
Periodic bulletins and newsletters can also change the terms of executed agreements. Participating agreements between healthcare providers and payers include requirements to comply with the payer’s managed care policies, as outlined in the healthcare provider manual....
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...
by Gustavo Matheus | Jun 23, 2015 | Appeals and Denials, Healthcare Reimbursement, Healthcare Updates, Payer Reimbursement, Revenue Cycle Management
Documentation is key to appealing denied claims What happens when a service that was thought to not need authorization, or was in fact preauthorized, is then denied? Depending on the reason for denial, there are options for providers seeking reimbursement for...
by Gustavo Matheus | Oct 28, 2014 | Hospital Revenue Cycle, Managed Care - General, Payer Reimbursement, Probate
by Ron Landsman, Esq. – Guest Contributor Note from Gustavo Matheus: When dealing with high-cost medical cases, oftentimes hospitals lose significant revenue simply because they fail to create special needs trusts. Since such an omission results in many missed...
by Gustavo Matheus | Sep 23, 2014 | Healthcare Reimbursement, Hospital Revenue Cycle, Managed Care - General, Payer Reimbursement
Given that a patient’s health records reveal highly personal and sensitive details, federal and state law protects patients against the unwanted disclosure of their private health information. And for healthcare facilities and physicians, a particular and recurring...
