With regard to reimbursement, our practice encompasses all areas of government and private payor reimbursement. Our attorneys regularly wage informal, judicial, and administrative challenges to statutory, regulatory, or contractual provisions of reimbursement programs.
We provide reimbursement advice to hospitals, nursing homes, physicians, and many other providers and suppliers on a wide range of issues involving payment disputes. We have counseled clients in disputes involving overpayment/underpayment demands, cost report disputes and Provider Reimbursement Review Board (PRRB) appeals, bankruptcy, provider-based versus freestanding designations, secondary payor issues, obtaining coverage for new drugs and devices, bad debt reimbursement, reassignment, and other challenges relative to reimbursement.
Our attorneys advise on operational or day-to-day reimbursement issues including Medicare, Medicaid, and third-party payor rates and methodologies, under arrangement agreements, global versus separate billing, proper coding practices, compliance with Medicare Conditions of Coverage and payment regulations, and waivers of co-insurance and deductibles.
Additionally, our healthcare team possesses considerable experience representing providers and suppliers in proceedings involving the PRRB, administrative law judges, Qualified Independent Contractors, Peer Review Organizations, administrative law judges, and federal and state courts.