Healthcare provider insurance contracts, statutes and regulation interpretation can be highly convoluted and complex. Insurance companies often misinterpret the terms of their provider services agreements, related rate tables and provider manuals. Conflicting and ambiguous contract language and related rate methods often result in lower than expected reimbursements.
We are keenly aware of the contract compliance issues that can arise which negatively impact your goal of realizing your insurance contracted rates. Our attorneys are very well versed in provider contracts and how they impact the bottom line of your organization. We have challenged and successfully overturned numerous global interpretations imposed by payers that are bias to their favor. Our goal is to eliminate erroneous payment policies which adversely affect your bottom line and to ensure these policies are in strict adherence to the provider agreement.
We will work with your organization to identify the payer contracts which are not being properly adhered to due to erroneous processing and/or payment policies. Once these contracts and related claim examples have been discussed and confirmed, we will directly participate in drafting a communication response to the insurance company on behalf of the healthcare provider regarding the specific payment policies along with quantification of affected claims for retrospective recovery and correction of future claim payments.
You will have assured confidence that these types of erroneous payment policies will be identified and effectively addressed with the payer to ensure all claims are paid in strict adherence to the healthcare provider agreement.