Modified Maryland Prompt-Pay Statute allows Health Plans to Delay, Withhold Payment of Claims
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...
read moreCMS Two-Midnight Rule for Medicare Payment poses Bureaucratic Headache for Hospitals, ER Physicians
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...
read moreAdvantage takes Advantage: DC Medicaid MCO’S Improper Hospital ER Payment Denial is Upheld
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...
read moreMilliman Published Criteria Poor Substitute for Medical Judgement in Payer Medical Claim Denials
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...
read moreMD Hospital – MCO Dispute Resolution Update: New Maryland Regulation for Independent Review
The Maryland Department of Health and Mental Hygiene has proposed a rule that significantly improves the dispute resolution process for healthcare providers appealing managed care organization (MCO) payment denials based on medical necessity grounds. Under the...
read moreReconsiderations in Health Plan-Provider Disputes
Solving the Problem of Utilization Review and Hospital Payment Denials Today’s health insurance plans—whether health maintenance organizations or traditional indemnity plans—must reimburse hospital, physician and other provider services only if they are deemed...
read more5 Ways Healthcare Providers Can Turn Electronic Records Into Electrifying Results
HEALTHCARE ANALYTICS: DATA THAT DELIVERS. At the same time hospitals and other healthcare providers prepare to comply with the Affordable Care Act, they have to deal with yet another sweeping new federal healthcare mandate: The American Reinvestment and Recovery Act...
read moreHow Hospitals Can Strengthen Managed Care Contracts: 5 Tips to Boost the Bottom Line
In today’s complex, rapidly changing healthcare environment, hospitals are facing enormous financial pressures and tight operating margins. For hospitals to stay in business, they must use every available tool to reduce costs, manage their relationships with health...
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