AGG’s Medicare/Medicaid Reimbursement Practice Team specializes in Medicare and Medicaid audits and appeals to help providers and suppliers prepare for and manage the new Recovery Audit Contractor (“RAC”) Program, the Medicaid Integrity Program (“MIP”) and other post-payment review initiatives. 

 

AGG attorneys have represented providers in post-payment and cost-report appeals for more than 25 years, successfully challenging medical necessity denials and prevailing in overturning statistically-extrapolated overpayment demands. We know the appeals processes and are ready to help providers navigate audit programs. 

 

In addition to our extensive appeals experience, certain team members are former clinicians, including a registered nurse, a rehabilitation therapist and other providers. Building on this vast clinical knowledge, we are uniquely positioned to assist providers in challenging medical necessity denials.

 

During the RAC Demonstration program, AGG attorneys worked with providers and suppliers faced with RAC audits and appealing denials. Now, we are preparing providers nationally for RAC audits and appeals. 

 

AGG attorneys have been at the forefront of the RAC audits and have spoken nationally on the process to educate providers. In addition, members of our team helped co-author the Georgia Hospital Association (GHA) RAC Readiness Manual for its members. 

 

Over the years, AGG attorneys have successfully represented providers and suppliers in the Medicaid appeals process. This experience has prepared the AGG team to work with providers in navigating the new MIP audits and appeals. 

 

Our team is actively working with providers in the state and region to address the new MIP audits, including advising providers on how to respond to expansive information requests. We have also raised concerns with CMS officials overseeing these programs and have initiated ongoing dialogue with the Agency as the audits continue.

 

AGG attorneys have worked with clients in responding to audits by Program Safety Contractors (PSCs), Comprehensive Error Rate Testing (CERT), the Office of Inspector General (OIG), and other CMS programs. As noted, we have successfully appealed medical necessity denials and statistical extrapolations used to support demands for substantial overpayments for hospitals, nursing homes, suppliers and a host of other providers. In addition to these ongoing appeals, we are currently working with several LTCHs subject to expanded reviews of medical necessity for admission and continued stays under the CHIP Extension Act of 2007.

 

AGG’s Medicare/Medicaid Reimbursement Practice Team works with all provider types and tailors its services to the particular needs of each provider, including: