by Christopher Oram | Nov 12, 2020 | Appeals and Denials, COVID-19 Updates
You might think that a health insurance company would not possibly contest the hospital treatment of an insured patient severely ill with COVID-19. Think again. COVID-19, also known as coronavirus, has created a global pandemic. More than 230,000 Americans have died...
by Gustavo Matheus | May 6, 2020 | Appeals and Denials, COVID-19 Updates, Healthcare Appeals, Healthcare Reimbursement, Managed Care Reimbursement
Healthcare Providers Must Insist HMOs Accept Electronic Filings An appeal recently filed with a health maintenance organizations (HMO) on behalf of a hospital was rejected because medical records were provided on a CD-ROM rather than on paper. That case involved 3,647...
by Jason Anderson | Nov 15, 2019 | Appeals and Denials, Business Law, Contract Review & Negotiation, General Litigation
Knowing the Collateral Litigation Exception to the American Rule Attorneys are always learning new things. Something I recently discovered relates to an exception to the normal attorney’s fees practices. It came up when an opposing counsel made a claim for attorney’s...
by Gustavo Matheus | Aug 1, 2019 | Appeals and Denials, Denied Claim Appeals, Denied Claims Litigation, Healthcare Appeals, Healthcare Reimbursement, Hospital Reimbursement, Managed Care - General, Managed Care Reimbursement, Payer Reimbursement, Provider Denials
Utilization management requirements often run counter to the medical standard of care When representing providers, I have noticed an unfortunate trend in recent years. Utilization management (UM) is encroaching upon the profession of medicine. With utilization...
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 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,...
