New Jersey Supreme Court case could expose physicians to large fines
The Supreme Court of New Jersey is reviewing a case about insurance fraud and a physician’s referral of patients to health care facilities where they have financial relationships. At issue is if fraud is based on what the medical group or practice should have known, as opposed to what they actually knew.
Court decides whether insurers can be sued for underpaid claims
A U.S. court of appeal ruled physicians who are assigned insurance policy benefits have the right to bring lawsuits against insurers who underpay for medically necessary services provided to covered patients.
Supreme Court to weigh insurer payment transparency
Health insurers are fighting a state law that would create transparency for physicians and patients when it comes to health insurance payments. A case before the Supreme Court of the United States will determine whether a technicality will stand in the way of reform efforts and keep the insurance payment process cloaked in mystery.
Ruling could give insurers more leeway to terminate physicians
The outcome of a recent case could have implications for other physicians and their patients as a federal court decided it was permissible for a large health insurer to terminate two physicians from its network following a dispute over the necessity of medical services they provided.
Court to weigh physicians' right to payments, recourse
Should physicians be left holding the bag when a private insurer retroactively denies a medical claim or recoups a payment? A federal appeals court is considering a case that could determine whether physicians have recourse to ensure that their practices remain financially stable so they can continue caring for their patients.
Common payment issues-and how to handle them
Physicians face many challenges in the day-to-day business of keeping a medical practice afloat, and one of the biggest is securing claims payments from health insurers. A new AMA resource helps physicians handle the process of identifying and appealing claims.
Court considers: Can doctors sue insurers for underpaid claims?
In North Jersey Brain and Spine Center v. Aetna, a physician practice that received assignments of benefits from patients with employer-sponsored health plans sued the insurer for denying and underpaying medically necessary surgeries for three different patients.
No more secrets: Insurer claim edits come into the light
Expensive claim denials and unexpected payment adjustments that stem from the hundreds of proprietary claim edits individual health insurers create behind closed doors could become a thing of the past in a few short years, thanks to an initiative underway in Colorado.
Essential Private Payer Tools & Resources
Evaluating & negotiating payment options
Overpayment recovery and claims appeals
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