by Chris Thibeault | 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 | 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 | Mar 25, 2014 | Appeals and Denials, Denied Claim Appeals
Often contained in payers’ participating provider agreements (PPAs) and provider manuals are criteria for accepting or rejecting medical claims. The problem for providers, leading to numerous legal disputes over denied claims, is that nowhere in the published care...
by Karen Kizer | Jan 28, 2014 | Appeals and Denials, Denied Claims Litigation, Healthcare Reimbursement
Solving the Problem of Utilization Review and Hospital Payment Denials Today’s health insurance plans—whether health maintenance organizations or traditional indemnity plans—must reimburse hospital, physician and other provider services only if they are deemed...
