by Gustavo Matheus | Aug 26, 2014 | Healthcare Reimbursement, Hospital Revenue Cycle, Managed Care - General, Payer Reimbursement
The purpose of the many state prompt-pay laws on the books is to ensure that health plans pay undisputed medical charges without delay or face steep late-payment interest rates in addition to the claim’s principal amount. For added protection against delinquent...
by Gustavo Matheus | Jul 22, 2014 | Denied Claim Appeals
In contract law, disproportionate forfeiture – paying nothing if a service is not completed precisely as agreed under the contract – is considered a penalty because of its failure to take into account the percentage of work completed. Disproportionate forfeiture and...
by Gustavo Matheus | Jun 24, 2014 | Payer Reimbursement
Chapter 368, House Bill 361, enacted last year by the Maryland General Assembly to complement the implementation of the Affordable Care Act, gives health plans another way to delay, and possibly deny, payments to hospitals and other healthcare providers. In effect...
by Christopher Oram | May 27, 2014 | Healthcare Reimbursement, Hospital Reimbursement, Hospital Revenue Cycle, Managed Care Reimbursement, Medicaid Reimbursement, Revenue Cycle Management
Published by the Centers for Medicare and Medicaid Services (CMS) in August 2013, the Inpatient Prospective Payment System/Long-Term Care Hospital Final Rule (CMS-1599-F) – known as the two-midnight rule – poses a bureaucratic headache for hospitals and treating...
by Gustavo Matheus | Apr 22, 2014 | Healthcare Reimbursement, Managed Care - General, Medicaid Reimbursement
Hospital emergency room doctors, nurses and technicians are our trusted first-responders who are legally bound to treat all patients, regardless of their ability to pay. And just as ER patients count on these life-saving emergency care providers, hospitals depend on...
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...
