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 | May 26, 2015 | Healthcare Reimbursement, Hospital Revenue Cycle, Managed Care - General, Revenue Cycle Management
Doctors and hospitals continue to lose significant revenue because of legal barriers to reimbursement built into their provider contracts. When healthcare providers, whether large healthcare organizations or individual medical practitioners, join a managed care...
by Gustavo Matheus | Apr 28, 2015 | Healthcare Reimbursement, Managed Care - General, Revenue Cycle Management
To Avoid Untimely Filing Denials, All Potential Payers Must be Billed Initially, Especially with MVA and MCO Accounts. One situation referred to my practice is a contracted provider fails to initially bill all potential payers. As a result, they must write off the...
by Gustavo Matheus | Mar 24, 2015 | Healthcare Reimbursement, Hospital Revenue Cycle, Managed Care - General, Medicaid Reimbursement, Revenue Cycle Management
When Injured Patient Arrives at ER, Hospital Managers Must Prepare for Interpleader Lawsuit, Seek to Recover Unpaid Medical Bills. From the moment a patient injured in an accident arrives at the emergency room, hospital administrators, emergency staff, and admitting...
by Gustavo Matheus | Dec 16, 2014 | Healthcare Reimbursement, Medicaid Reimbursement, Revenue Cycle Management
The recent offer made to qualifying hospitals by the Centers for Medicare and Medicaid Services proposing partial payment for disputed claims is a teaching moment: Hospitals must submit timely appeals or face significant financial losses. To read more about this,...
