Resources to Decrease Denied Medical Claims.
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Home | Articles & Case Studies

Articles & Case Studies

  Displaying Matches 17 thru 32 of 123 Found.  BACK NEXT
Lost Medical Records
Lost Medical RecordsSubmitting medical records to insurance carriers for medical review is a time consuming but unavoidable medical billing activity. Many insurance carriers require documentation on any medical treatment which is above and beyond standard. . . .more >>
Will Managed Care Pass The Texas Test?
A group of more than 450 Texas physicians made headlines around the nation in for their decision to drop out of Aetna's U.S. Healthcare Physician Network. . . .more >>
Managed Care Contracts: AKA Mangled Care Contracts
Learn why mangled care can be an excellent system to be a part of, promote or profit from...if you're an insurance carrier. . . .more >>
Negotiate a Better Managed Care Contract
Healthcare billing personnel often begin to view the provider–carrier relationship as an adversarial, often dysfunctional partnership, and improving that relationship may be low on a long priority list of urgent action items. . . .more >>
Another Day in the Paradise of Managed Care Reimbursement
Another Day in the Paradise of Managed Care ReimbursementIt has happened again... another reimbursement check and Explanation of Benefits (EOB) has arrived from a Managed Care Organization (MCO) with an amount less than what you believe is due to you under your MCO agreement. What do you do now. . . .more >>
Who's Reviewing Your Appeals? Man or Machine?
Who's Reviewing Your Appeals? Man or Machine?Appeals involve highly technical issues such as clinical guidelines, specialty coding standards, quality of care and contract requirements. It takes a highly qualified appeal reviewer to respond appropriately. However, carrier appeal responses fall short again and again. . . .more >>
Never Talk to the Monkey When the Organ Grinder is Available
Never Talk to the Monkey When the Organ Grinder is AvailableInsurance companies receive, review and uphold thousands of medical appeals each year. Should you be detered if you receive a letter stating your appeal letter was reviewed and the decision to deny payment was upheld. . . .more >>
Seven Tips To A Successful Medical Necessity Appeal
Seven Tips To A Successful Medical Necessity has a number of letters citing state and federal disclosure laws which assist medical providers with demanding more complete information regarding denials. These letters are under the. . . .more >>
CASE STUDY: Responding to Insurance Denials Due to Lack of Medical Necessity
CASE STUDY: Responding to Insurance Denials Due to Lack of Medical NecessityA medical provider has received an insurance denial due to lack of medical necessity. To review the correctness of this action, the provider’s office obtains the carrier’s policy definition of medical necessity. . . .more >>
Submitting Peer-Reviewed Literature with Medical Necessity Appeals: My Evidence vs. Your Evidence
Submission of peer-reviewed literature can strengthen medical necessity and experimental/investigational appeals. Insurance companies have a duty to review information submitted during an appeal. Furthermore, an insurance company’s failure to. . . . more >>
Medicare Appeal Changes Requires Early Submission of Documentation
The success of Medicare appeals frequently hinges on the quality of the supporting documentation. The early and thorough gathering of documentation is even more essential under the new Medicare Claims Appeal Procedures which were partially implemented May 1. . . .more >>
Medicare Names QIC for Physician Appeals
Medicare’s new Part B Fee-For-Service appeal procedures went into effect Jan. 1, 2006. As part of the new procedures, physicians may now file Level II appeals with Q2Administrators, the first independent contractor named for reviewing physician appeals. . . . more >>
Medicare and Medical Necessity
The Social Security Act provision limiting Medicare coverage to medically necessary services and supplies uses broad language to reference this highly important coverage variable. Specifically, Section 1862(a)(1)(A) of the Social Security Act states the following. . . .more >>
Tactics To Recover Medicare Underpayments
When you treat a patient who's a member of a Medicare plan and you don't have a contract with that plan, you expect to be paid the full amount you're entitled to under Medicare. But many providers are getting shortchanged. . . .more >>
Mental Health Care Appeals: Seeking Compliance with the Mental Health Laws
State and Federal Mental Health Parity laws have given many behavioral health treatment providers hope regarding mental health care reimbursement. However, a Governmental Accounting Office report studied the effect of mental parity mandates and found that. . . .more >>
Appealing Lack of Timely Filing After a MSP Denial
CMS is undertaking a comprehensive effort to collect money owed to Medicare due to incorrect payments related to coordination of benefits. The result is that providers often learn of group health coverage by way of a letter requesting repayment of an incorrect Medicare payment. . . .more >>

  Displaying Matches 17 thru 32 of 123 Found.  BACK NEXT