HEALTH PROVIDER PAYMENT DISPUTES

Payment disputes frequently arise between healthcare providers and health insurance plans. Some disputes are covered by contracts between the parties. Others are governed by state laws. Others arise because of the lack of any black-letter law determining the payment due. These disputes often involve claims for several million dollars in additional payment for past services. Decisions in these cases can affect millions of dollars in payment for services in the future.

RPC has over 20 years direct experience in medical bill review, and utilization review. Our team of economists, health care administrators, accountants, nurses and physician advisors has analyzed billing disputes involving a wide range of health care services, health care providers and insurance programs. RPC can provide analysis of individual bills, payment policies and the payment process including the following:

• Compliance with provider contracts
• Compliance with state fee guidelines and payment policies
• Definition of usual and customary fees
• Compliance with state utilization review laws
• Compliance with uniform billing and coding standards
• Reasonable documentation of services
• Compliance with reconsideration and appeal procedures

For sample RPC reports and professional references please contact Ron Luke at (512) 371-8000