In CMS’ efforts to improve the quality of care, as of October 1, 2008 Medicare will not pay for certain injuries/conditions acquired during inpatient care, these injuries/conditions have been named by CMS as “never events” or “hospital acquired conditions” (HACs). CMS has advised state Medicaid Agencies to amend their statutory language to ensure that payment is not made through Medicaid for those beneficiaries that may have dual eligibility. Read the rest of this entry »
Posts Tagged ‘Billing’
Malpractice- Medicare will not pay for “Hospital Acquired Conditions a.k.a “Never Events”
Wednesday, May 19th, 2010Medicare Denied Claims and Conditional Payments
Thursday, October 29th, 2009Medicare claim denial is unfortunately a common problem that Medicare beneficiaries are faced with. Medicare has the highest denial rate of any insurer pursuant to the 2008 National Health Insurer Report Card commissioned by the American Medical Association (AMA, www.ama-assn.org):
![DenialsByInsurer2008[2]](http://www.liensettlementsolutions.com/lienresolution/wp-content/uploads/2009/10/DenialsByInsurer20082.jpg "DenialsByInsurer2008[2]")
Before we start making hasty assumptions about government health care programs, lets look at some of the reasons why claims have been denied by Medicare. 33.6% of adjustments and 33.7% of denials are due to inaccurate reporting by the providers. Some of the common billing errors that providers make are:
Ask a Lien Professional – Provider refuses to bill Medicaid!
Thursday, October 8th, 2009Question:
I have a case where the hospital has a claim that needs to be submitted to Medicaid for payment. However, since the hospital knows that there is a liable third party, they are refusing to submit the claim to Medicaid. How can I force the hospital billing office to submit the claim for payment? – FL Attorney
Answer:
In this instance, the provider has the right to go either way, so there is no real avenue to “force” a provider to bill Medicaid for services. Under Medicaid’s provider agreement, the hospital has the right to bill all other insurers first, with Medicaid being the final payer. On the other hand, Medicaid has the right to subrogate for payments made when a third party is responsible.
Medicaid as Final Payer – Why the Provider can bill liable insurer:
FL Statute 409.907(3)(f) – Medicaid Provider Agreement
(3) The provider agreement developed by the agency, in addition to the requirements specified in subsections (1) and (2), shall require the provider to: Read the rest of this entry »
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