With over a decade of experience in the health care industry, Attorney Oliver D. Tomas provides advice and counsel to hospitals, physicians, and other health care professionals – with a particular focus on reimbursement/contractual disputes between providers and payors. As a health care attorney, Mr. Tomas has assisted health care organizations in transactions, corporate matters, operations issues, litigation, and government investigations.
In addition to serving as outside counsel to major California hospitals and health systems, Attorney Tomas was assistant general counsel for Prime Healthcare Management, Inc.
While at Prime, Mr. Tomas provided legal services in such areas as managed care, contracting, and health care reimbursement litigation. Attorney Tomas also served as corporate counsel for Prospect Medical Holdings, Inc. and as in-house counsel for a specialty pharmacy.
In this special episode, attorney Thomas discussed the top 10 reasons the healthcare insurance companies use to deny claims, strategies to prevent denials, and the appeal process.
He also explored the techniques used to enhance reimbursement. Denial for reimbursement for medical services rendered continues to be challenging for providers and hospitals, and analysis by change healthcare in 2017 indicated that out of approximately 3 trillion and medical claims submitted by hospitals last year, almost 9% of charges were initially denied. Hospitals and providers must be fully educated on the legal pitfalls and strategies to minimize hospital reimbursement claim denials.