Our attorneys are highly experienced in reimbursement litigation, audits and appeals involving claims denials, cost report disputes, enrollment controversies, redeterminations, payment suspension and recoupment actions. We routinely guide clients through audits and investigations conducted by the Centers for Medicare and Medicaid Services (CMS), Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RACs) Medicare Administrative Contractors (MACs), Medicaid Integrity Contractors (MICs), the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), and state inspector generals and regulatory agencies throughout the country. We assist our clients in conducting internal investigations and identifying potential error rates, responding to records requests, and providing written and oral advocacy before enforcement authorities to avoid enforcement actions.
Successfully addressing appeals activities involves an integrated approach on various levels, including: (1) preparing for and responding to the initial audit; (2) efficiently and effectively managing the appeals process at all levels of appeals; and (3) counseling clients on compliance issues. Our approach is one of a partnership with our client’s internal team to ensure effective communication and enhance results throughout the entire process, from the beginning stages of the audits, through appeals and beyond.
We work with clients to establish processes that will ensure efficient, organized, and responsive replies to audit requests. Our collaboration with clients on education, policies, procedures and communication can minimize avoidable unfavorable decisions. Proper documentation responses and organization at the initial stages of the audit provide the foundation for successful appeals later in the process.