Why Medical Providers and their attorneys should care about the outcome of Armstrong v. Exceptional Care Center
by Carole Stewart Anhalt, J.D., LL.M., M.H.A. Note from Gustavo Matheus: Doctors and hospitals continue to lose significant revenue because the courts, legislatures and government agencies are often unwilling to acknowledge that healthcare quality and access are...
read moreHow Hospitals Can Help Protect Patient Records, Personal and Financial Information Under the Affordable Care Act
With the revamping of the federal HealthCare.gov insurance website, the Affordable Care Act has entered its second year – Obamacare 2.0. In the new year, one often-overlooked problem involves the security of patients’ private information – protected health information...
read moreRecent Lessons from CMS: To Avoid Losses, File Timely Appeals
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,...
read moreFive Reasons to Update Managed Care Contracts
Managed care revenue fuels hospital operations, which is why hospitals’ managed care contracts require careful maintenance. Still, the firm sometimes sees hospital clients with stale five- or 10-year-old contracts – and costly problems left unresolved. As a general...
read moreSpecial Needs Trusts: Helping Hospitals Increase Medicaid Recoveries for High-cost Medical Cases
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...
read moreHow Hospitals Comply with HIPAA Privacy Rules in Personal Injury Attorney Requests for Records
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...
read moreWorking-Capital-Allowance Loophole Hurts Hospitals by Denying Interest on Unpaid Claims
The purpose of the many state prompt-pay laws on the books is to ensure that health plans pay undisputed medical charges without delay or face steep late-payment interest rates in addition to the claim’s principal amount. For added protection against delinquent...
read moreHospitals Dispute Disproportionate Forfeiture as Penalties for Breach of Managed Care Contracts
In contract law, disproportionate forfeiture – paying nothing if a service is not completed precisely as agreed under the contract – is considered a penalty because of its failure to take into account the percentage of work completed. Disproportionate forfeiture and...
read moreModified Maryland Prompt-Pay Statute allows Health Plans to Delay, Withhold Payment of Claims
Chapter 368, House Bill 361, enacted last year by the Maryland General Assembly to complement the implementation of the Affordable Care Act, gives health plans another way to delay, and possibly deny, payments to hospitals and other healthcare providers. In effect...
read moreCMS Two-Midnight Rule for Medicare Payment poses Bureaucratic Headache for Hospitals, ER Physicians
Published by the Centers for Medicare and Medicaid Services (CMS) in August 2013, the Inpatient Prospective Payment System/Long-Term Care Hospital Final Rule (CMS-1599-F) – known as the two-midnight rule – poses a bureaucratic headache for hospitals and treating...
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