Areas of Practice

Reimbursement Counseling & Appeals

We believe that the needs of providers and suppliers can be best served by an in-depth understanding of Medicare, Medicaid and other third party reimbursement.  In keeping with that belief, our Firm proactively counsels providers and suppliers on the regulatory intricacies of third party reimbursement, including:

• Billing, coding, claim submissions and cost reporting
• Medical necessity, coverage and claims denials
• Reopenings and recoupment of overpayments
• Hospital inpatient and outpatient prospective payment systems (PPS)
• Physician resource-based relative value scale (RBRVS)
• Reasonable cost reimbursement
• Home health PPS
• Skilled nursing facility PPS
• Disproportionate share hospital (DSH) adjustments
• Graduate medical education (GME) payments
• Cost outlier adjustments
• Bad debt payments
• State Medicaid programs

In addition, we have significant experience representing providers and suppliers in third party payment disputes, controversies and administrative proceedings involving:

• Medicare Intermediaries and Carriers
• Medicare Administrative Contractors (MAC)
• Durable Medical Equipment Regional Carriers (DMERC)
• Regional Home Health Intermediaries (RHHI)
• Qualified Independent Contractors (QIC)
• Provider Reimbursement Review Board (PRRB)
• Administrative Law Judges (ALJ)
• Departmental Appeals Board (DAB)
• State Medicaid agencies