Fierce Healthcare

Providers' advantage on out-of-network billing disputes likely to continue: Capstone

Insurers hoping for a reprieve from an out-of-network billing system largely favoring healthcare providers will likely be left wanting as federal policymakers sit on their hands and one large payer’s ...
Hosted on MSN

Mastering claim denials and appeals for providers

Healthcare providers lose billions annually to claim denials, yet many go unchallenged. By combining proactive prevention, strong appeal strategies, and smart negotiation, organizations can recover ...
Health Affairs

Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent

This article quantifies the prevalence of claim denials in Medicare Advantage (MA), along with their direct impact on provider revenue. Employing medical claims data from multiple MA plans, covering ...
JD Supra

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

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 ...