Although seemingly informal, administrative appeal hearings are anything but. They are civil litigation proceedings governed by the rules of evidence and civil procedure. Failing to preserve issues, submit evidence, and place objections on the record can end a good appeal before it even gets started, resulting in a significant loss of Medicaid/Medicare revenue, well over […]
Medicaid/Medicare Administrative Appeals: Exploring the Pros and Cons of Provider Staff or Consultants Handling Appeal Hearings. Although seemingly informal, administrative appeal hearings are anything but. They are civil litigation proceedings governed by the rules of evidence and civil procedure. Failing to preserve issues, submit evidence, and place objections on the record can end a good […]
Teaming up to force state and MCO compliance with federal statutes and CMS Regulations. When states and MCOs don’t follow CMS approved state master plans & master contracts, CMS Regulations, or even federal statutes, costing providers significant revenue, commencing litigation against them on your own can seem daunting and expensive. When a group of providers […]
The Trick to Dealing with MCOs To whom do I report issues? CMS and state agencies – until you know whom to report the problems, you are playing on an uneven field. Understanding how this works will increase your revenue. How? Know and understand your contracts and have concerted efforts.
By: Bernadette Smith, Managing Director, LTC 100 Intelligence Group Chad Bogar, Managing Partner of sb2, recently sat down with David Ellis, Founder & President of Lincoln Healthcare Leadership and the LTC 100 Intelligence Group to discuss various widespread MCO issues that providers are currently facing and how to remedy bad MCO behavior. First, Chad discusses […]