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3 Min Read

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.

Judicial Advocacy
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3 Min Read

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.

Judicial Advocacy
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2 Min Read

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.

Judicial Advocacy
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2 Min Read

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.

Judicial Advocacy
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3 Min Read

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.

Claims Processing
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2 Min Read

3 things you must know about overpayment recovery

Learn what you need to know about the overpayment recovery process with these three tips and additional assistance from a free online overpayment recovery toolkit from the AMA.

Claims Processing
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1 Min Read

Insurers not paying correctly? Free tool helps address denials

The Claims Workflow Assistant, developed by the AMA, can help your practice understand digital explanations of payment known as electronic remittance advice (ERA) transactions and address any issues with how the insurer handled your claims.

Claims Processing
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2 Min Read

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.

Judicial Advocacy
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3 Min Read

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.

Claims Processing