Recovering the Usual and Customary Rate- What the Healthcare Provider Should Know

The settlements reached earlier this year between New York Attorney General Andrew Cuomo and a group comprised of the largest health insurers in the United States have prompted a series of lawsuits throughout the country against major health plans such as Wellpoint, AETNA, and Cigna. A summary of this litigation can be found on this […]

Selling Healthcare Receivables through Established Relationships- The Benefit of Forward Flow Agreements

Selling delinquent debt has become commonplace in many industries, but it remains limited in the healthcare arena, for many reasons. Hospital financial services executives remain concerned with maintaining control over their account inventory and minimizing public relations risks. Moreover, the unique nature of medical debt requires that healthcare providers conduct considerable due diligence before embarking […]

Out-of-Network Healthcare Provider Payment News

Florida Senate Bill 1122 takes effect today. The law amends Florida Statutes section 627.638 to require health insurers to make payment directly to hospitals, physicians, and other providers of treatment when the provider is not a member of the insurer’s network. Previously, despite the patient’s assignment of healthcare benefits to the provider upon admission, some […]

HITECH Act's Changes to HIPAA Privacy Rule Soon Taking Effect

Covered entities and business associates subject to the HIPAA Privacy Rule, including health care providers and revenue cycle vendors, should take note that the amendments to the Rule brought about by the Health Information Technology for Economic and Clinical Health Act, §§13400-13424 of the American Recovery and Reinvestment Act of 2009 (the “HITECH Act”), take effect […]

Welcome to Healthcare Provider Payment

Welcome to Healthcare Provider Payment, a blog authored by Medical Accounts Systems and Jorge M. Abril, P.A. Here we will discuss relevant news and emerging trends in healthcare reimbursement, from insurance litigation news and Managed Care contracting issues, to health law and policy. We maintain this site as a service to our existing clients and […]

Out of Network Provider Payment and Balance Billing under the Patient Protection and Affordable Care Act

One of the most common issues we encounter between providers and payors is how the provider should be paid for treating a patient who is covered by a health plan that doesn’t have a contract with the provider. We’ve previously written about it here, in the context of insurers’ controversial use of the Ingenix database […]

United States Supreme Court Expands Remedies Available to Healthcare Providers and Patients Under ERISA

The United States Supreme Court recently ruled in CIGNA Corp. v. Amara, 563 U.S. ____, 348 Fed. Appx. 627 (May 16, 2011), that a fiduciary of an Employee Benefits Plan (including a Health Plan) can be sued for unpaid benefits under ERISA § 503(a)(3). Previously, courts had been reluctant to order payment of money under […]