There are two main areas in which Quadrino Schwartz is providing industry-leading services for medical providers. The first area is combatting claim denials and forcing health insurers to pay valid claims. The second area is successfully defending medical providers when health insurers pursue refunds of monies they have already paid to the providers, such as in post payment reviews or health insurance audits.
As to claim denials, there are numerous issues that revolve around the proper procedures that the health insurers must follow under both the federal ERISA regulations and state law. Using our extensive knowledge of the law in this field, we seize upon the use of improper procedures, protect the rights of the medical providers, and obtain payment on valid claims that had been denied. Quadrino Schwartz is becoming a leader in this field and is using its extensive ERISA experience to collect thousands of dollars for medical providers.
On the health insurance “audit” front, there is a national trend in which health insurers are pursuing medical providers for refunds of monies that the insurers previously paid to the providers on past claims. The insurers begin their efforts with “audits” or ”post payment reviews” of the medical providers’ prior billing on previously closed and paid claims. The medical providers have more defenses available to them than they realize, and they should employ counsel to either resist such audit requests or have qualified counsel manage the process. In the vast majority of situations, the health insurers have no entitlement to a refund whatsoever and are using the process to intimidate the medical provider. These providers need the help of experienced health insurance lawyers to identify their defenses so that they have the greatest chance of success in these circumstances. Quadrino Schwartz is also on the cutting edge in this area of health insurance law and has a track record of success in defending medical providers.
If you are a medical provider facing an audit or want to pursue payment for denied health insurance claims, contact Quadrino Schwartz. Our experienced and dedicated team of health insurance attorneys is ready to fight for you.