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 | Feb 17, 2015 | Healthcare Reimbursement
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...
by Gustavo Matheus | Jan 27, 2015 | Healthcare Reimbursement
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...
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,...
by Gustavo Matheus | Nov 18, 2014 | Contract Review & Negotiation, Medicaid Reimbursement, Revenue Cycle Management
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...
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...
by Gustavo Matheus | Aug 26, 2014 | Healthcare Reimbursement, Hospital Revenue Cycle, Managed Care - General, Payer Reimbursement
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...
by Gustavo Matheus | Jul 22, 2014 | Denied Claim Appeals
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...
