Healthcare Reimbursement Disputes
Commercial Payer/Internal Appeals
– Medical necessity
– Improper discounts
– Eligibility issues
– Coordination of benefits and Timely filing denials
– Non-covered services or Experimental treatment denials
– Pre-certification penalties
– Pre-existing conditions
– Usual & customary rate denials
– Delay in services denials
– Payment rescission and refund requests/offsets
Government/Administrative appeals
– “Fee for Service” Medicare
– “Fee for Service” Medicaid
– U.S. Dept. of Labor
– Workers’ Compensation (Federal and State)
– Recovery Audit Contractor (RAC) defense
– Medicare Appeals Council (MAC) appeals
Automobile liability subrogation
ERISA and third-party administrator negotiation
Anderson & Quinn Healthcare Attorneys
Rob P. Scanlon
Managing Member
Alice Kelley Scanlon
Member
From the blog
HHS Inspector General Report finds that Medicare Advantage Organizations improperly deny nearly 1 in 5 payment requests
On April 27, 2022, the Office of the Inspector General for the U.S. Department of Health and Human Services (“OIG”) released a report finding that Medicare Advantage Organizations (“MAOs”) are issuing unnecessary denials resulting in delayed care for patients and...
read moreWho’s Paying the Medical Bill?
By: Hailey Groover, Legal Assistant Conflicts in Coordination of Benefits Under Maryland Insurance Article § 15-1008 Healthcare providers occasionally run into situations where a patient will have coverage under two health plans. Ironically, because of...
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