By: Pearl Walia Changes in politics, public policy, and economic conditions continue to influence contract negotiations between healthcare payers and providers. Shifts in reimbursement legislation, regulatory requirements, Medicaid eligibility rules, and compliance obligations all affect how parties evaluate contractual provisions. As a result, payer disputes remain a persistent and significant challenge across the healthcare industry. Payers include health insurance companies and other entities that finance or administer healthcare benefits. Because providers and payers frequently disagree on issues such as medical necessity, coverage limitations, prior authorization requirements, and coding accuracy, reimbursement disputes have become a recurring revenue cycle management concern for…
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