Medical reimbursement notes from AdvimedPro.
Summaries of AdvimedPro blog topics by Martine G. Brousse: claim rejections, medication coverage, Medicare appeals, provider networks, and reimbursement review.
Avoid "Duplicate" rejections !
A practical reminder that duplicate claim rejections can come from timing, resubmissions, corrected claims, or mismatched billing references.
Get a Formulary Exception
How to organize a formulary exception request when a needed medication is not covered as expected.
Medicare Advantage plans: 5 levels of Appeals
A plain-language overview of how Medicare Advantage appeal escalation can move through five review levels.
Is your Provider acceptable by your insurance?
A network-focused post about verifying whether a provider, facility, or service is acceptable under a specific plan.
The Importance of Cents in the Healthcare Payment System
Why small dollar differences, exact balances, and payment posting details can matter during medical reimbursement review.
The Five Appeals Levels of Original Medicare
A concise map of the Original Medicare appeal route, from first review through later escalation.
Avoid Out of Network Reimbursement Issues
What to check before submitting or disputing an out-of-network reimbursement request.
Fix Out Of Network Clinical and Billing Records Problems
How to separate clinical-record issues from billing-record issues when an out-of-network claim is hard to process.
Avoid Paying for Medical Mistakes
A patient-side reminder to review bills and records before accepting a balance that may reflect an administrative mistake.
Getting Medical Records Errors Amended
How to organize a request when medical-record errors may be affecting billing, claim review, or patient history.
Brown- and White-Bagging: an unhealthy Trend
A healthcare payment topic covering specialty medication handling and how it can affect billing, access, and coordination.
What does "Usual & Customary" mean?
A reimbursement primer on how usual and customary language can appear in out-of-network payment discussions.