In today's regulatory climate, business deals are structured in order to take advantage of or avoid the consequences of unique, discrete Medicare and Medicaid billing and claims administration rules. We use our experience in decoding these rules and communicating with regulators to provide clear guidance to clients on Medicare and Medicaid payment issues.
We help clients respond to government audits by conducting reviews of clinical and billing practices, compiling and analyzing data for defense of claims, and representing them throughout the response and appeal process. During the process, we understand that it is important to maximize client reimbursement while complying with payor rules and regulations. We frequently provide advice on billing and coding conventions, the use of modifiers and location codes, and supervision requirements for ancillary services.
In connection with client transactions and expansions, we assist healthcare providers with Medicare/Medicaid provider enrollment, changes of ownership, application updates, and reassignment. The firm also routinely represents clients before state and federal agencies related to overpayments and recoupment actions involving Medicare and Medicaid claims.
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