Article 28 Facilities No-Fault Collection Provider
Article 28 is a public health law for regulating and recognizing accreditation of public health care facilities so that the facilities are legally licensed and run. Article 28 provides that certain facilities are licensed to perform particular types of procedures which for other reasons might not lawfully be performed.
Article 28 does not only relate to hospitals, however; it also covers surgical centres and nursing homes.
High Standards of Healthcare Services
High standards of health care services for the state of New York is embodied in Article 28. It helps to establish that public healthcare facilities are operative and actual. Thus, accreditation with regards to the Article 28 process implies that a facility works in accordance with the tightest of standards.
Coding and billing under Article 28 can be more complicated than even for a medical facility that has not yet met the designation. The regulatory requirements and documentation standards are significantly more stringent.
Expert Support from HBS
The team from Hired Billing Support has years of experience handling cases with such significant claims behind a healthcare provider, so they have the required knowledge and experience to take on these claims when they are filed on behalf of the healthcare facility.
Why Choose HBS? Our specialists understand the unique challenges of Article 28 facilities and have successfully navigated the complex reimbursement landscape for numerous New York healthcare providers.
Understanding the No-Fault Insurance Law
However, because the services healthcare professionals who are accredited under Article 28 provide are more expensive, to some degree, this is because they have to be willing to pay the bills to ensure that high standards of care are met.
As Article 28 facilities provide a higher cost of care, the carriers are very interested in controlling those costs, so more scrutiny is put on them.
Common Reimbursement Denials Under New York's No-Fault Laws
However, in some cases the insurance companies are reluctant to pay out these bills. However, there can be many reasons why they will deny your No-Fault claim and the most common reasons are as follows:
Lack of Medical Necessity
The most common denial is that the insurer simply says the treatment provided by your facility was not "reasonable and necessary" and therefore, it is not covered under the No-Fault law. The insurers will collaborate with an independent physician to generate a peer review-based medical denial claiming the care was unnecessary.
Independent Medical Exam Findings
An IME (Independent Medical Exam) is another way insurance companies "verify" a patient's condition before paying your claims. The examining physician might rule that the patient's recovery is complete or minimize injuries. Insurance companies will deny claims referring to that opinion.
Missing Documentation
To get reimbursed, you must supply the insurance company with detailed documentation of care. Ignoring verification requests, even unjustified ones, can result in permanent claim denial. Always ensure every facility claim includes full supporting documentation.
Need Expert Help with Article 28 Claims?
Our team has the specialized knowledge to navigate New York's complex No-Fault reimbursement landscape. Let us help you maximize your reimbursements and reduce denials.