Health Care Reimbursement

The attorneys in Miller Johnson’s Healthcare Reimbursement Group provide litigation and counseling to medical providers seeking insurance reimbursement on patient accounts. Our group pursues wrongful denials of hospital claims by third-party payers, including no-fault carriers, health insurance plans and government plans.

We generate revenue for medical providers through litigation and training in:

  • Health plan denials including priority disputes, pre-authorization disputes, denials for pre-existing conditions, COBRA eligibility and ERISA preemption;
  • No-fault denials, ineligibility, eligibility, coverage issues and priority issues;
  • Insurance payment issues, including partial payments, mistaken payments, “customary and reasonable” payments and balance billing issues;
  • Contractual issues and audits with government payers, group health plans and managed care entities; and,
  • Lien or fee claims against hospitals from attorneys representing patients in liability claims.

The attorneys in the Healthcare Reimbursement Group seek and collect interest and attorney fees from carriers for wrongful denials by enforcing state and federal laws requiring prompt payment of claims. Often, the penalties collected exceed the underlying claim.

We provide each client with a detailed spreadsheet that is accessible via a protected Extranet site. We also provide timely legal updates through our electronic bulletin called “Client Alerts.”

Our group’s litigation and counseling have provided our hospital, health system and medical provider clients with a much-decreased timeframe in accounts receivable and significant decreases in self-pay accounts, charity and uncollectible write-offs.  Overall, we have increased collections overall by pursuing improperly denied claims.

We have increased collections overall by pursuing improperly denied claims. In the past 3 years, we have collected more than $93 million in denied charges and over $1.88 million in interest and attorney’s fees. These were from payors which have denied and delayed payment of claims, adding more than $76.7 million in net revenue to our clients’ bottom lines.

In addition to appealing and litigating denied claims, our group provides training to Patient Financial Services representatives on billing and coding issues, no-fault eligibility and coverage issues, appeals to government payers, HMOs and ERISA plans on denied claims and compliance under the Fair Debt Collection Practices Act.  We have also designed and implemented Denial Management Protocols for our hospital clients.  We provide both in-house training seminars and e-mail notifications regarding legal issues affecting reimbursement.