by Admin Anderson Quinn | Aug 4, 2021 | Healthcare Reimbursement, Healthcare Updates, Managed Care - General, Managed Care Reimbursement
Why Insurance Article § 15-1009 Should be Applicable to Managed Care Organizations This is the second of two articles regarding Maryland laws in need of updating. By: Jason C. Anderson and Gustavo Matheus In our last article, found here, we discussed the need for...
by Admin Anderson Quinn | Jun 3, 2021 | Healthcare Reimbursement, Healthcare Updates, Managed Care - General, Managed Care Reimbursement
Why Healthcare Providers Should Insist on Laws Requiring Payment of Services Denied for Lack of Authorization: A Maryland MCO Case Study. This is the first of two articles regarding Maryland laws in need of updating. By: Robert P. Scanlon and Gustavo Matheus Two of...
by Jason Anderson | Jul 21, 2020 | Denied Claim Appeals, Denied Claims Litigation, General Litigation, Healthcare Reimbursement, Hospital Reimbursement, Managed Care - General, Managed Care Reimbursement, Medicaid Reimbursement
Why litigation may be the best option in Maryland to recover denied claims Since its inception in 1997, Maryland’s HealthChoice program has expanded to provide healthcare coverage to a majority of Maryland’s Medical Assistance (“Medicaid) recipients. Through its...
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 | 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...
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...
