Guides

Guides

Medical Claim Denials: Top 10 Denials in Medical Billing and How Providers Respond

A medical claim denial is an adverse payment decision after a payor processes a claim. The code on the remittance advice identifies the stated adjustment, but the provider’s next step depends on the cause: missing information, a correctable claim detail or a dispute about coverage or payment terms. Ian James

California Hospital Lien Act: A Provider Guide to Civil Code 3045, Lien Perfection and Subrogation

For California providers, the hospital lien act california framework offers a statutory route to assert a claim against damages recovered for an injured patient’s care. The governing provisions are California Civil Code Sections 3045.1 through 3045.6, not the Code of Civil Procedure. Ian James

What Percentage Recovery Rate Should a Hospital Expect From Healthcare Litigation Services?

what percentage recovery rate should a hospital expect from healthcare litigation services Hospital finance teams asking “what percentage recovery rate should a hospital expect from healthcare litigation services” need a benchmark tied to the type and stage of the claims. Ian James

Medi-Cal Reimbursement: A Provider’s Guide to Billing, Codes and Denials

For hospital finance and revenue-cycle teams, Medi-Cal reimbursement depends on more than the service code. Payment can turn on provider type, date of service, Medi-Cal program and whether the claim runs through fee-for-service or a managed care plan. Ian James

Should Your Hospital Use a Lien Recovery Service? How It Fits Alongside Your Revenue Cycle Team

should our hospital use a lien recovery service if we already have a revenue cycle management team For hospital finance leaders asking, “should our hospital use a lien recovery service if we already have a revenue cycle management team,” the deciding issue is the work involved. Ian James

Prior Authorization Denial: Reasons, Denial Codes and the Provider Response Path

A prior authorization denial can involve missing or mismatched authorization information, or a clinical disagreement about the requested service. These issues require different first steps. Ian James

Healthcare Litigation Services for Payor Contract Disputes: How Hospitals Pursue Recovery Without Disrupting Operations

best healthcare litigation services for payer contract disputes without disrupting hospital operations Hospitals evaluating the best healthcare litigation services for payer contract disputes without disrupting hospital operations should first identify the disputed contract obligation, the claims... Ian James

Insurance Recoupment: A Provider’s Guide to Appeals and Letters

An insurance recoupment can reduce provider revenue before a dispute is resolved. The response depends on the payor’s authority: the contract, notice rules, deadlines or state law. Review the demand against each applicable source. Ian James

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