Reimbursement Audits & Appeals

As the healthcare industry continues to grow and healthcare costs continue to rise, healthcare providers face increased scrutiny from the Centers for Medicare & Medicaid Services and their contractors, as well as other federal and state agencies. We advise clients on a broad range of regulatory and reimbursement issues, from evaluating appropriate billing practices to handling pre- and post-payment audits, including UPIC, RAC, and state Medicaid audits. In addition, hospital, nursing home, home health, hospice, and other healthcare clients benefit from our extensive experience with navigating the administrative appeals process and voluntary disclosure process at the federal and state level.

Our specialties include counseling clients through challenging statistical sampling and extrapolation, medical record review, and organization to respond to additional documentation requests, the navigation of the various settlement initiatives for providers caught in the appeals backlog, and responding to litigation-related TROs.