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 Virginia Vile Tehrani | Jun 19, 2018 | Criminal Defense, General Litigation
Speed Trap: How driving through Virginia could land you in more trouble than you knew Imagine this scenario. You’re on the interstate in Virginia heading to work, racing traffic to get to the airport, or just driving through on I-495. You figure it will be safe to go...
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 John Rego | Mar 10, 2017 | Anderson & Quinn News
We are pleased to announce that, Robert Scanlon, Managing Member, and Gustavo Matheus, Member, are now admitted to practice law in the Commonwealth of Virginia and are members of the Virginia State Bar. Rob represents clients in the fields of : Business and Corporate...
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 Philip Wright | Nov 11, 2016 | Construction Disputes, General Litigation
Victor Espinoza knows a thing or two about winning. He’s won the Kentucky Derby three times and he’s the last Triple Crown champion since 1978. He also knows, as his silks state, that under Maryland law any person who plans to dig underground must call “Miss...
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...
by Curtis Hane | Aug 29, 2016 | General Litigation, Workers Compensation Litigation
Providing effective and successful vocational and job search services in Maryland workers’ compensation claims can be a win-win for both claimants and employers. Whether voluntarily agreed upon by the parties to a claim or ordered by the Workers’ Compensation...
by Rob Scanlon | Jul 29, 2016 | Contract Review & Negotiation, Healthcare Reimbursement
The inefficiencies of arbitration clauses in healthcare provider contracts invalidate their value. Healthcare providers frustrated with excessive denials from managed care payers have asked us to examine their provider service agreements. One question commonly asked...
