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 | 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 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 | 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....
