Our health industry clients deserve to be paid appropriately and on time for the valuable services and goods they provide to patients. Butzel Long’s Health Industry Group counsels health industry clients on Medicare, Medicaid, Blue Cross/ Blue Shield, HMOs, commercial insurers and other third party payer requirements. Getting paid an appropriate amount in a timely manner requires a thorough understanding of reimbursement principles and coverage requirements. The lack of uniformity and sometimes conflicting rules of different private and governmental payers makes understanding and complying with these myriad rules a real challenge. Attorneys in the Health Industry Group work with clients and payers to create viable business models and business relationships and to maximize reimbursement consistent with the lawful application of reimbursement principles.
Our health industry clients deserve to be paid appropriately and on time for the valuable services and goods they provide to patients. Butzel Long’s Health Industry Group counsels health industry clients on Medicare, Medicaid, Blue Cross/ Blue Shield, HMOs, commercial insurers and other third party payer requirements. Getting paid an appropriate amount in a timely manner requires a thorough understanding of reimbursement principles and coverage requirements. The lack of uniformity and sometimes conflicting rules of different private and governmental payers makes understanding and complying with these myriad rules a real challenge. Attorneys in the Health Industry Group work with clients and payers to create viable business models and business relationships and to maximize reimbursement consistent with the lawful application of reimbursement principles. Business models and relationships entered into without a solid grasp of payment and reimbursement implications may need to be restructured, with increased cost and lost time, loss of goodwill and even serious cash flow and regulatory consequences. Butzel Long attorneys advise clients in the following areas: · Medicare and Medicaid conditions of participation · Medicare Part A (hospital inpatient services, hospice, SNF, home health agency) · Medicare Part B (physician services, hospital outpatient services, DMEPOS, outpatient surgical services, FQHCs, ASCs, IDTFs, ambulance services, community mental health centers, drugs and biologicals, etc.) · Medicare Part C “Medicare Advantage” · Medicare Part D prescription drugs · Provider and supplier enrollment, participation agreements, 855, NPI and payer contracting and negotiation advice · Coverage and payment · Program administration (quality improvement organizations QIOs; Medicare administrative contractors MACs; recovery audit contractors RACs; prescription drug plans PDPs’ and Part C insurance providers) · Management of overpayment situations · RAC and other payer audits · Assignment and reassignment · “incident to” and physician supervision requirements · mark ups and anti-mark ups · professional services of nonphysician practitioners (physical therapists, clinical psychologists, licensed clinical social workers, certified nurse midwives, certified registered nurse anesthetists (CRNA), physician assistants, nurse practitioners, clinical nurse specialists, audiologists) · Designated health services (DHS) and ancillary services (x-ray, CT, MRI, PET, sleep studies) · Issues involving professional and technical components of purchased diagnostic tests · Provider based rules · DRGs and RBRVS fee schedules · Graduate medical education (GME)