Two Important MSP Rulings

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 Selected for “2015 Business Partner of the Year” Award by HomeTown Health

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..

UPDATE: March 2015

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 Liability Insurers Misleading You In North Carolina?

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..

Do Your Homework On Assignment Of Benefits

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..

An Untimely Lien Doesn’t Have To Mean Case Closed

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..

Managed care and insurance network contracts

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..

White Paper: A Road Map for Simplifying Motor Vehicle Accident Claims and Maximizing Revenue Recovery

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..

Workers Compensation Case Study

We will actively represent the hospital in all pending claims, interevening when allowed and negotiate resolution of the hospital charges, especially in controverted cases. We also pursue underpayments, a common occurrence in workers compensation claims and all penalties that attach by statute.

Liability Claims Case Study

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.

Commercial Collections Case Study

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

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..

Third Party Liens – An Underused Source of Revenue

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..

Why is Our Logo a Bridge?

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..