As pioneers in the health care legal industry, our attorneys and government relations professionals understand the complexities of obtaining coverage, coding and appropriate reimbursement for our health provider, pharmaceutical, biotechnology and medical device manufacturer clients. We assist these clients regularly with developing solutions to reimbursement issues.

Our team members have longstanding relationships with key policymakers, federal agencies, the Centers for Medicare and Medicaid Services (CMS), state Medicaid and Medicare offices, the American Medical Association, and other governmental or quasi-governmental agencies. Our team includes reimbursement attorneys who formerly represented Medicaid programs in New Jersey and Pennsylvania.

On health care reimbursement issues, we often work closely with our Health Care Compliance and Fraud Investigations practice, our Federal Government Relations practice and our Food and Drug/FDA lawyers. In addition to handling routine health provider reimbursement issues, these practices work together to help our clients with:

• Reimbursement matters related to new technology.
• Upper payment limit and disproportionate share programs for academic medical centers and faculty practice plans to maximize Medicaid reimbursement.
• Understanding the rules related to resident and intern supervision and reimbursement for graduate medical education.
• Reimbursement matters related to organ transplant program.
• Issues such as provider-based status, incident to billing, related parties, purchased diagnostic tests, telemedicine and global surgery billing.
• Written compliance plans with hospital policies and procedures that reflect federal and state statutes and regulations regarding direct and indirect graduate education reimbursement.

Recently, we have:

• Provided advice to a medical equipment company regarding options and strategies to address fundamental changes in Medicare reimbursement for power wheelchairs.
• Represented a medical equipment manufacturer in its attempts to have the federal government revise its reimbursement code to include a product that provided not only traditional value, but also therapeutic value. Within two weeks of the engagement, the change in reimbursement coding was announced by the head of the administration at an annual industry conference.
• Representing a health care provider in a $14 million Medicare administrative appeal before the Provider Reimbursement Review Board.
• Successfully increased Medicaid reimbursement through rate appeals and court actions totaling $800,000 for two providers.
• Successfully reversed a number of Medicaid audits in 2001 totaling over $4 million for different providers.
• Successfully negotiated with the Medicare Intermediary regarding improper activities by an outside therapy provider and change of ownership issues.