by Rob Scanlon | Jul 29, 2016 | Contract Review & Negotiation, Healthcare Reimbursement
The inefficiencies of arbitration clauses in healthcare provider contracts invalidate their value. Healthcare providers frustrated with excessive denials from managed care payers have asked us to examine their provider service agreements. One question commonly asked...
by Gustavo Matheus | Apr 29, 2016 | Healthcare Reimbursement, Interpleader Action Defenses
Healthcare providers must promptly assert billing rights in personal injury cases before patient resolves personal injury claim From the time a patient who has suffered personal injuries is treated in the hospital’s emergency room, the facility, physicians, 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,...
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....
