FloridaHealthlawfirm

Providing Legal Services to Physicians and Healthcare Business with the Right Pricing , Responsiveness & Ethics

Payer Problems

In Network Payment Recovery

While your healthcare business may be compliant with billing regulations and coding, this does not mean that your payer is compliant and has paid you correctly per your contract. Providers know that Fraud and Abuse has been one of the largest areas of focus for payers and the government over the past 20 years. Due to this attention, many healthcare businesses engage auditors to audit their compliance of claims quarterly or annually. However, in addition to compliance audits, a provider should be auditing their payer interaction to create a dynamic blueprint of denial management and payment recovery.

The Florida Healthcare Law Firm offers a convenient flat fee screening for providers as a way to determine the potential for their healthcare business to obtain outstanding contractual payments.

Use the following checklist to determine your eligibility for this flat fee screening:

Do you have?

  • Copies of payer contracts
  • Provider remittances for reduced or denied claims
  • Medical records to supplement claims provided (paper or electronic)
  • Payer fee schedule
  • Applicable payer correspondence

Monitoring denial reasons, payment reductions, and denial codes by payer for trends is a key factor when putting together a preventive plan of action. Providers who believe they meet the above criteria can call the Florida Healthcare Law Firm toll free at (888) 455-7702 for a free consultation to determine eligibility for the flat fee screening.

Out of Network Payment Recovery

Out of network practices and healthcare businesses may be compliant with billing regulations and coding, but that does not mean the payer is compliant with the laws that pertain to out of network services. Providers know that Fraud and Abuse has been one of the largest areas of focus for payers and the government over the last 20 years. Moreover, out of network insurers often allege provider wrongdoing (e.g. waiver of copays and deductibles) as a way to (a) avoid paying an out of network provider, or (b) recapture amounts paid. The Florida Healthcare Law Firm offers experienced counsel to out of network providers and healthcare businesses forced with payer nonpayment who can effectively remedy getting paid and avoiding payer recoupment.

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