News & Analysis as of

Hospitals Insurance Claims

Proskauer - Health Care Law Brief

No Surprises Here!  Payers Push Back on IDR Submissions, Opening New Front in NSA Implementation Landscape

On May 27, 2025, Blue Cross Blue Shield Healthcare Plan of Georgia (“BCBSGA”) sued several emergency physician groups and their billing agent, Halo MD, alleging abuse of the No Surprises Act’s (“NSA”) independent dispute...more

Tyson & Mendes LLP

Calculating Past Medicals in California

Tyson & Mendes LLP on

The Third District Court of Appeal in California recently addressed the standard in proving the reasonableness of charges for past medical services within the context of the Hospital Lien Act’s definition of emergency and...more

Davis Wright Tremaine LLP

Navigating Aetna's Expanded Claim Edits: What Providers Need To Know and Do Before September 1, 2025

Aetna recently announced that effective September 1, 2025, its Claim and Code Review Program (CCRP) will expand to include additional claim coding edits for all commercial, Medicare, and Student Health claims. While the...more

Davis Wright Tremaine LLP

Two California Appellate Decisions Highlight Liability Risks Arising From Hospital "Conditions of Admission" Forms and Billing...

In the ever-evolving world of healthcare billing, two recent reported California appellate court decisions, Naranjo v. Doctors Medical Center of Modesto and Dameron Hospital Association v. Progressive Casualty Insurance...more

Carlton Fields

Tenth Circuit Interprets Excess Policy’s Definition of “Medical Incident” as Applying to the Injuries of One Single Person

Carlton Fields on

On May 2, 2025, the Tenth Circuit Court of Appeals issued an opinion in AdHealth Limited v. PorterCare Adventist Health Systems affirming the lower court’s summary judgment ruling that a hospital’s excess liability insurance...more

ArentFox Schiff

Navigating Out-of-Network Claims: Key Takeaways for Providers From Surgery Center Case in New York Federal Court

ArentFox Schiff on

The US District Court for the Eastern District of New York in Manalapan Surgery Ctr., et al. v. 1199 SEIU National Benefit Fund, No. 23-CV-03525 (EDNY March 12, 2025), recently granted a motion to dismiss a complaint filed by...more

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - March 2024

Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more

McDermott Will & Emery

Hospitals: Check Your Addresses or Face Medicare Claims Returns!

McDermott Will & Emery on

Following an implementation delay during the COVID-19 public health emergency (PHE), on August 1, 2023, the Centers for Medicare and Medicaid Services (CMS) initiated Medicare hospital claims edits that will return certain...more

Health Care Compliance Association (HCCA)

Long-Haul COVID-19 Cases Are Potential Risk for Claim Denials

Report on Medicare Compliance 30, no. 17 (May 3, 2021) - With the pandemic in its second year, coding and documentation of long-haul COVID-19 patients who are admitted or readmitted to the hospital may be a sleeper risk....more

American Conference Institute (ACI)

[Webinar] Navigating New Risks and Litigation Challenges Facing Payors in the COVID-19 Context and Beyond - May 13th, 12:00 pm -...

What will the post-pandemic world look like? What risks and challenges will it raise and how to navigate the new litigation landscape? These are the most relevant questions amid the pandemic. To respond to them and provide...more

K&L Gates LLP

K&L Gates Triage: Activation of Validation Edits for OPPS Providers with Multiple Service Locations

K&L Gates LLP on

The Centers for Medicare and Medicaid Services (CMS), recently announced that it plans to activate systematic validation edits for Outpatient Prospective Payment System (OPPS) providers with multiple service locations that...more

Bricker Graydon LLP

Hospitals with off-campus provider-based departments: Check your PECOS enrollment file

Bricker Graydon LLP on

Now is the time to double and triple check your Medicare Provider Enrollment, Chain, and Ownership System (PECOS) enrollment file to make sure all information for off-campus provider-based service locations is correct. ...more

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