11th Circuit Issues Two Important Rulings on the Medicare Secondary Payer Act In August, 2016, the U.S. Court of Appeals for the Eleventh Circuit issued significant rulings on two important Medicare Secondary Payer Act (“MSP”) provisions. Both rulings involve cases originally filed in Florida. I. Humana Medical Plan Inc. v. Western Heritage Insurance Company “This… Continue Reading..
Allgood Professional Services was presented the “2015 Business Partner of the Year” award by HomeTown Health, an organization of 70 rural hospitals in the Southeast, at HomeTown’s 16th Annual Fall Conference held at Callaway Gardens October 21-23, 2015. “This coveted award is presented each year by HomeTown Health to one of 60 Business partners who… Continue Reading..
In an important turn of events, the Georgia Supreme Court reversed the Court of Appeals in Hospital Authority of Clarke County v. Geico General Insurance Co., 294 Ga. 477; 745 S.E. 2nd 358 (2014). Noting that the specific language of OCGA 44-14-473(a) states the one year limitation to enforce a lien begins to run at… Continue Reading..
Are North Carolina liability insurers misleading you? A look at Rule 414 of the North Carolina Rules of Evidence All attorneys handling personal injury claims in North Carolina should now be familiar with Rule 414 of the North Carolina Rules of Evidence. Prior to the passage of Rule 414 in 2011, injured plaintiffs could introduce… Continue Reading..
This month, just five years after we first opened our doors, Allgood Professional Services passed a significant milestone. We’re proud to have recovered $100 million for our clients in that time. And, while we’re not ones to rest on our laurels, we’d like to take a moment to pause and reflect on the practices that… Continue Reading..
An Assignment of Benefits (“AOB”) typically looks like every other contract we see from a large organization (think of your Verizon cell phone contract); lot’s of legalese and boilerplate language. But, what does an AOB really mean to the hospital and how does it control disbursement of funds from insurance available to the patient? To… Continue Reading..
The Georgia hospital lien statute requires strict compliance in order to properly perfect a lien. Unlike many of my DIY projects at home, corners cannot be cut and shortcuts cannot be taken when filing these liens. The good news for providers, however, is the Georgia statute provides one “out” should the provider miss a filing… Continue Reading..
Anyone Miss Full-Service Gas Stations? Do you remember pulling into a full-service gas station back in the day, rolling down the window and telling the gas station attendant you needed a full tank of gas? Pretty nice wasn’t it? You got to roll the window back up and think about the rest of your day… Continue Reading..
Managed care and insurance network contracts continue to be exceedingly one sided in favor of the insurers. It is time to change and we will suggest how through a series of articles. This first article will focus on workers’ compensation and how a carefully worded contract with an insurance network can be extremely important to… Continue Reading..
My guess is the term “Masters” popped into your mind and not necessarily “quality” as you read this headline. Yes, each spring, Augusta opens her doors to golf fans from around the world for the world’s greatest sporting event. Our city becomes alive and we put on our “Sunday Best” as we roll out the… Continue Reading..
One of the provisions of Georgia’s hospital lien statutes requires a hospital to file a lawsuit within one year after “the date the liability is finally determined” by one of four events: 1) settlement, 2) a release, 3) a covenant not to sue or; 4) a judgment.1 Knowing the date when the one year limitations… Continue Reading..
Motor Vehicle Accident (MVA) claims are complex, time consuming, and often unprofitable unless handled correctly. For one, the odds are stacked against the provider, because almost all such claims involve legal issues unrelated to the care of patients. Meanwhile, for the 8th year in a row, the majority of hospital CEO’s (according to the American… Continue Reading..
A recent decision by U. S. District Judge William Duffie, Jr. halted the enforcement of a 2011 amendment to Georgia’s prompt pay statute. This amendment, which was to take effect January 1, 2013, would have required self funded employee benefit plans and their third party administrators to comply with the time limits placed upon health… Continue Reading..
We review any account for potential third-party recovery, file hospital liens according to state statute and complete all necessary follow-ups in order to satisfy the lien at the time the liability claim is settled. This is a potentially significant area of revenue for trauma and emergency care centers. In addition to reviewing accounts to determine if there is a liability claim to pursue, we also make recommendations on pursuing payment from secondary insurers such as Medicare, Medicaid, or commercial health insurance.
When dealing with commercial insurers such as managed care payers and ERISA plans, we assist in collecting underpayments, wrongful denials, appeals, improper discounting, precertification issues and coverage questions. We are prepared to get involved at any level in the collection process. We will evaluate all assigned accounts to determine the chances of additional recoveries including penalties. We will also exhaust all administrative appeals when necessary and pursue litigation if justified.
MOST FAVORED NATION CLAUSES GET CHALLENGED It has finally happened! Hurray for some good lawyers in North Carolina and Alabama for filing extensive and well pleaded class action lawsuits challenging, among other things, the “most favored nation” (MFN) clauses contained in most every Blue Cross Blue Shield contract with health care providers The MFN provisions… Continue Reading..
In 2007 over 2.5 million people were injured in automobile collisions. Many received treatment for those injuries in an emergency room or trauma center and at least 16% had no medical insurance. Most, if not all of the patients injured in automobile collisions will pursue a legal claim against the at fault party and receive… Continue Reading..
Webster’s Dictionary defines a bridge as 1 a : a structure carrying a pathway or roadway over a depression or obstacle 1 b : a time, place, or means of connection or transition According to the United States Bureau of Transportation Statistics, there are approximately 600,000 bridges in the United States alone! Some are… Continue Reading..