Top Areas for Improved Claim Appeals in Hospitals First in a Series
Over the last 37 years, we see common areas of opportunity where Hospital can improve collections and reduce claim denials
Dispute Resolution Provisions: Most managed care contracts require arbitration, but hospitals pay little attention to this provision. Here’s what to consider:
- Make sure a dispute resolution vendor is specified, if the American Arbitration Association (AAA), specify health care rules. American Health Lawyers Association (AHLA) is also a good choice.
- Make sure mediation is REQUIRED before arbitration. (It’s faster, cheaper and often resolves the dispute) Specify mediation to take place within a certain mile radius of the hospital. Specify either state certified mediators or on of the vendors from a.
- Pay attention to the time limits and deadlines: time to provide notice of dispute, time between notice of dispute and demanding mediation, time limit to file arbitration etc.
- Specify parties to pay their own costs and attorney’s fees
- Pay attention to ANY areas of the contract that exclude certain areas of conflict from this dispute resolution; utilization review is an example. Avoid excluding any areas from the dispute resolution, unless you agree to go to court on those issues.