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Provider Reimbursement Disputes

Healthcare providers face challenges unlike other businesses in obtaining (and keeping) payment for their services. The complexity of healthcare reimbursement is a result of the prevalence of third-party payment, opaque payment methodologies, arduous and ever-changing regulatory paradigms, and other market factors. This reduces practice revenue and eats up time that could be spent treating patients and focusing on outcomes.

Seeking Full and Fair Payment for Healthcare Providers and Their Patients

We counsel our clients on how to handle third-party claims submissions from the moment the patient walks in the door for the first time to when the patient is discharged, and a significant balance remains unpaid. We stress the importance of meticulous documentation, both clinical and administrative, and strict adherence to the administrative appeal processes available.

If this diligence falls short, we rely upon our extensive knowledge of both Medicare and private insurance carrier reimbursement, including ERISA, to vindicate our clients’ rights in negotiation and litigation, on both an individual and, where appropriate, a classwide basis.

Our efforts have secured tens of millions of dollars in previously denied or underpaid benefits, including one of the largest class action settlements ever by a commercial health carrier with a class of licensed healthcare providers.

Defending Providers in Payment Audits and Overpayment Litigation

While providers have seen a dramatic rise in refund requests and overpayment demands from both Medicare and commercial payers over the last decade, these disputes have been a core focus of our firm from the first day we opened our doors.

No law firm in the country can match the scope and breadth of our experience in defending providers in both post-payment and pre-payment audits. For almost 20 years, we have defended providers in disputes involving allegations of improper coding and claim submissions, kickbacks, self-referrals, improper practice structure, and medically unnecessary services.

Today we routinely counsel providers (and their attorneys) throughout the country in overpayment disputes with both governmental agencies and private insurance carriers.

  • Posted on: Dec 22 2017