Managed Care Advisor

The medical profession seems to be psychologically conditioned into thinking that they have no leverage when dealing with reimbursement problems on patients’ claims that are payable by the commercial payors. But in an article entitled “You Have More Leverage Than You Think When Dealing With Denials”, Richard Quadrino dispelled a few notions, laid out a vision for more effective claim reimbursement, and provided insight as to certain critically important rules of the road.

The Managed Care Advisor, a publication that focuses on Contracting & Reimbursement, sought Rick’s input on how to deal with various intractable situations, such as vague denials, lack of responses on claims, and global or widespead denials of a similar type. Do the doctors continue to repeatedly submit endless reams of medical records and jump through “appeals” hoops, or is there some other, more effective strategy available?

Richard’s front page feature piece started by informing the readers that old stacks of EOBs, perhaps getting yellowed from the sun on a windowsill, could actually be a stack of $1,000 bills, if one understands how to address claim denials by using the federal ERISA law as the main weapon.

Quadrino Law Group seeks to hold the payors in compliance with the claims process that is legally mandated by the U.S. Department of Labor. The applicable set of federal regulations are enshrined in law, under ERISA, and when health insurers and claim administrators violate the law, the consequences can be very favorable to the medical providers.

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