Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Maximizing reimbursement by appealing claim denials.

James W Marks1

  • 1Harris Kessler & Goldstein LLC, Suite 590, 640 N. LaSalle, Chicago, IL 60610, USA. jmarks@hkgold.com

The Journal of Medical Practice Management : MPM
|March 23, 2005
PubMed
Summary

Healthcare providers can recover lost revenue by understanding administrative appeal processes. Recent regulatory changes for the Employee Retirement Income Security Act (ERISA) offer new avenues for increasing reimbursement rates.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Silent PPOs: the stealth discounting of provider reimbursement.

The Journal of medical practice management : MPM·2005
Same author

Prompt pay statutes for physicians' billing claims: an imperfect remedy for a systemic problem.

The Journal of medical practice management : MPM·2005
See all related articles

Area of Science:

  • Healthcare Administration
  • Health Law
  • Medical Economics

Background:

  • Providers incur significant financial losses due to payer's non-compliant practices.
  • Understanding administrative appeal processes is crucial for financial recovery.
  • Contractual and statutory frameworks govern these appeal processes.

Purpose of the Study:

  • To highlight the financial impact of payer abuses on healthcare providers.
  • To emphasize the importance of administrative appeals for reimbursement.
  • To inform providers about recent regulatory amendments beneficial to them.

Main Methods:

  • Analysis of payer practices and their financial consequences.
  • Review of administrative appeal processes as defined by contracts and statutes.

Related Experiment Videos

  • Examination of recent regulatory amendments impacting provider reimbursements.

    • Main Results:

    • Providers are losing millions of dollars annually due to payer misconduct.
    • Effective administrative appeals can lead to increased reimbursement rates.
    • Amendments to ERISA regulations provide favorable conditions for providers.

    Conclusions:

    • Healthcare providers must leverage administrative appeals to combat financial losses.
    • Knowledge of appeal processes and regulatory changes is essential for financial health.
    • ERISA amendments present an opportunity for providers to improve revenue cycles.