by Don Maiberger | Jun 30, 2016 | General Litigation, Workers Compensation Litigation
In recent years, the number of cases involving the use of opioid medication as a regular course of treatment for chronic pain, failed back syndrome, poor surgical results, and other non-life threatening conditions have increased. Workers’ Compensation Commissions,...
by Gustavo Matheus | Apr 29, 2016 | Healthcare Reimbursement, Interpleader Action Defenses
Healthcare providers must promptly assert billing rights in personal injury cases before patient resolves personal injury claim From the time a patient who has suffered personal injuries is treated in the hospital’s emergency room, the facility, physicians, and...
by Gustavo Matheus | Mar 30, 2016 | Appeals and Denials, Healthcare Appeals, Healthcare Reimbursement
Solving the Problem of Utilization Review and Hospital Payment Denials by Karen Kizer, Senior Paralegal – Gustavo Matheus, Esq., LLC Today’s health insurance plans—whether health maintenance organizations or traditional indemnity plans—must reimburse hospital,...
by Admin Anderson Quinn | Dec 3, 2015 | Appeals and Denials, Healthcare Appeals, Healthcare Reimbursement, Healthcare Updates, Hospital Reimbursement, Hospital Revenue Cycle
Medicare’s Consolidated Billing Rules for Home Health Beneficiaries Apply to Hospital Claims. In reviewing denied claims referred to our office, it is my experience that hospitals must be aware of Medicare’s Consolidated Billing rules when providing services to home...
by Gustavo Matheus | Oct 29, 2015 | Appeals and Denials, Denied Claim Appeals, Healthcare Appeals, Healthcare Reimbursement, Healthcare Updates, Hospital Reimbursement, Provider Denials
Timely appeals help preserve rights of healthcare providers. The signed agreements between healthcare providers and managed care plans regulate the terms of the parties’ business relationship. These terms, often detailed in the payer’s provider manual, seem simple:...
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 | Jul 28, 2015 | Healthcare Reimbursement, Healthcare Updates, Hospital Reimbursement, Hospital Revenue Cycle, Managed Care Reimbursement
Most health plans have contracts with hospitals that require billing within 180 days of the date of service. Some self-insured plans allow hospitals to submit their bills for up to a year. There are strict statutes in place to ensure these billing deadlines are...
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...
