Use of Opioid Medication for Pain Management and Workers’ Compensation Cases
In recent years, the number of cases involving the use of opioid medication as a regular course of treatment for chronic pain, failed back syndrome, poor surgical results, and other non-life threatening conditions have increased. Workers’ Compensation Commissions,...
read moreProtecting the Rights of Healthcare Providers in Interpleader Actions
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...
read moreReconsiderations In Health Plan-Providers Disputes
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,...
read moreProvider Responsibilities When Treating Medicare Home Health Beneficiaries
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...
read moreBenefits of Exhausting Appeals
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:...
read moreBeware of Hidden Loopholes in the Provider Manual
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....
read moreJoint Operating Committees: Providers Must Learn to Leverage JOCs
What would you tell health plans if you had the chance to talk to them in person? Typically, participating agreements between healthcare providers and payers include requirements for a Joint Operating Committee (JOC) meeting, as an opportunity to address and resolve...
read moreTimely Billing: To Avoid Lost Payments, Hospitals Need to Bill All Potential Payers From the Start (Part Two)
Most health plans have contracts with hospitals that require billing within 180 days of the date of service. Some self-insured plans allow hospitals to submit their bills for up to a year. There are strict statutes in place to ensure these billing deadlines are...
read moreWhen You Hear “Prior Authorization is Not a Guarantee of Payment”
Documentation is key to appealing denied claims What happens when a service that was thought to not need authorization, or was in fact preauthorized, is then denied? Depending on the reason for denial, there are options for providers seeking reimbursement for...
read moreKey Reasons Why Arbitration Clauses Are Costly to Providers
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...
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