NOT Medically Necessary BUT Reimbursable
When Healthcare Services that are not Medically Necessary can be Reimbursed. Providers that know this one exception to the rule are less likely to leave money on the table. A mainstay of managed care is that coverage applies only to medically necessary services....
read moreVirginia Speed Traps: What You Need to Know
Speed Trap: How driving through Virginia could land you in more trouble than you knew Imagine this scenario. You’re on the interstate in Virginia heading to work, racing traffic to get to the airport, or just driving through on I-495. You figure it will be safe to go...
read moreMedical Necessity 101
How healthcare providers can avoid getting tripped up by the medical necessity requirement. The world of medical claims is littered with booby traps that can catch providers off guard. Our law practice has found that healthcare service providers often get tripped up...
read moreConfusion in Pre-Certification/Pre-Authorization Denials
Insurance standardized codes can cause confusion for healthcare providers. In 2008, Medicare updated its policy to require contractors to employ standardize codes in paper and electronic Remittance Advice (RA) forms. Derived from Health Insurance Portability and...
read moreAnnouncement: Newest Virginia State Bar Members
We are pleased to announce that, Robert Scanlon, Managing Member, and Gustavo Matheus, Member, are now admitted to practice law in the Commonwealth of Virginia and are members of the Virginia State Bar.
read moreIt’s Off to Work You Go. Are You Covered for Workers’ Comp?
First and foremost, the Going and Coming Rule in workers’ compensation in Maryland essentially says, “The employee cannot get workers compensation benefits for injuries happening while going to work or coming home from work.”
read moreWinners Call 811 Before Digging Each Time, EVERY TIME
Victor Espinoza knows a thing or two about winning. He’s won the Kentucky Derby three times and he’s the last Triple Crown champion since 1978. He also knows, as his silks state, that under Maryland law any person who plans to dig underground must call “Miss...
read moreThe Importance of Clinical Documentation in Interfacility Air Ambulance Transport Services
Payers of healthcare providers’ claims demand documentation in support of air ambulance services – emergency room staff must consider risk of denial. Most healthcare practitioners are aware that hospital emergency departments are required by EMTALA to treat those...
read moreSuccessful Vocational Rehabilitation In Maryland: A Defense Perspective
Providing effective and successful vocational and job search services in Maryland workers’ compensation claims can be a win-win for both claimants and employers. Whether voluntarily agreed upon by the parties to a claim or ordered by the Workers’ Compensation...
read moreChallenges of Arbitration Clauses in Provider Managed Care Agreements
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...
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