The Plaintiff’s Source for MSP Compliance Solutions

Posts Tagged ‘Hospital’

How Health Care Reform May Affect Settlements

Wednesday, March 31st, 2010

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act of 2010 into law.  The enactment of this law heralds a new era in American health care and insurance practices.  Though there are many conflicting views on the changes that the law creates, there will definitely be a shift in how insurance companies and health care providers operate from now on.  In reviewing the basics of Health Care Reform, there are many aspects that may have an affect on future settlements in cases where an insurance company or provider has made payment.  It will be important in the coming months and years for attorneys to be aware of the status of their client’s insurance eligibility and enrollment, and to continue to remain compliant throughout the case management process.

Based on some of the basic tenents of the Patient Protection and Affordable Care Act of 2010,  here are a few things that the trial bar may see in the future: Read the rest of this entry »

Ask a Lien Professional – Provider refuses to bill Medicaid!

Thursday, October 8th, 2009

Question:

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 »