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Opportunity for Reimbursement from UHCIC

Date: November 21

On March 29, 2013 the Florida Department of Financial Services issued a “Notice to Medical Providers” regarding the liquidation of Universal Health Care, Inc. (UHC) and Universal Health Care Insurance Company, Inc. (UHCIC). The Notice was sent to providers whose records indicated they “may have provided medical services” to members/policyholders of UHC and UHCIC. If you have any denied claims for UHCIC it may not be too late to get paid for those claims.  Although the Proofs of Claim deadline was in 2014, we believe that we can file late claims for a limited period of time, until approximately November 30, 2016. If you have any claims denied by UHCIC with service dates between 02/01/2012 and 03/31/2013, we would be happy to pursue them on your behalf.

The Receiver has announced that Class 2 medical providers (i.e. those for whom Proofs of Claim were filed by the 6/30/14 deadline) will be paid in full at 100% of the claim pricing, and will be paid prior to any remaining class of creditor. Providers with late filed claims will be Class 8 creditors (not Class 2 priority). However, based on the published financial statements of the Receivership, it is expected that Class 8 creditors will also be paid in full at 100% of claims pricing. We are aware of providers who are expected to receive large payments on aged claims that were written off years agoWe can pursue any denied or underpaid UHCIC claims dating from 02/01/2012 through 03/31/2013, and medical providers are expected to be paid in full at 100% of the of claim pricing.

If you choose to pursue this opportunity please contact us at (410) 296-5192 or email Gail Robinson at g.robinson@washingtonwest.com.

 

CMS Announces 2016 Hospital Appeals Settlement Call

Date: October 28

On September 28, 2016 the Centers for Medicare and Medicaid Services (CMS) announced that it will “once again allow eligible providers to settle their inpatient status claims currently under appeal using the Hospital Appeals Settlement process.” At the time of the announcement no details on the new settlement offer were provided. Today, CMS announced that they will host a 2016 Hospital Appeals Settlement Call on November 16, 2016, from 1:30 to 3:00 P.M. CMS has created a Hospital Appeals Settlement Process 2016 webpage and indicated that details on the settlement process will be posted to the page in early November. Registration for the November 16th call is required and can be submitted through the MLN Connects Upcoming Events page.

Sarah Mendiola to Present at Association for Clinical Documentation Improvement Specialists (ACDIS) Annual Conference

Date: May 18

W&W Director of Clinical Services and Senior Attorney, Sarah Mendiola, will present at the 9th Annual Association of Clinical Documentation Improvement Specialists (ACDIS) Conference in Atlanta, Georgia on May 25th.  Ms. Mendiola’s presentation, titled Completing the Circle: The Importance of CDI Specialist Participation in the Denial Management Process, will discuss best practices for CDI specialist participation in denial management.  The interactive session will present actual examples of costly denials that could have been prevented with CDI specialist intervention. Examples will include 2-midnight denials, medical necessity for surgical denials (as outlined by CMS), and justification of MCCs that are difficult to support clinically while maintaining compliance guidelines.

OMHA Announces Settlement Conference Facilitation (SCF) Pilot Open Door Call

Date: September 17

An email on behalf of the OMHA Medicare Appellant Forum announced today that the Office of Medicare Hearings and Appeals’(OMHA) had scheduled an open door teleconference which will discuss  expansion of its Settlement Conference Facilitation (SCF) Pilot.  The open door teleconference will be held on October 15, 2015 at 1:00pm-2:00pm.

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