Laddaga Garrett | TOP AREAS FOR IMPROVED CLAIM APPEALS IN HOSPITALS FIRST IN A SERIES
15831
post-template-default,single,single-post,postid-15831,single-format-standard,ajax_fade,page_not_loaded,,qode-title-hidden,side_area_uncovered_from_content,qode-child-theme-ver-1.0.0,qode-theme-ver-16.7,qode-theme-bridge,disabled_footer_top,wpb-js-composer js-comp-ver-5.5.2,vc_responsive

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:

  1. 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.
  2. 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.
  3. 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.
  4. Specify parties to pay their own costs and attorney’s fees
  5. 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.