Medicare, Medicaid, & Private Payor Audit Defense & Appeals
Medicare, Medicaid, and third-party payors all engage in significant auditing activity, often using the services of outside contractors to assist in their claim reviews. There is a veritable alphabet soup of government contractors performing data analysis and/or medical reviews of claims submitted by health care providers and suppliers: CERT, QIO, MAC TPE, SMRC, RAC, and UPICs. Providers and suppliers should act now to prepare for increased claims scrutiny.
Our attorneys understand not only the steps involved in an audit and the appeals processes but also the best practices for providers and suppliers to incorporate within their ongoing compliance efforts to place them in the best position to avoid unfavorable audit results. The attorneys of The Health Law Partners, P.C., have years of experience successfully appealing thousands of claim denials on behalf of many providers and suppliers, including hospitals and health systems, hospices and home health agencies, durable medical equipment (DME) companies and physicians.