Practice

Medicare & Medicaid Reimbursement for Providers

Helping you make sense of the Medicare and Medicaid programs

Medicare and Medicaid are the largest healthcare payers in the United States. As a provider, you rely heavily on their ever-changing regulatory policies. Our attorneys monitor program regulatory and subregulatory changes daily; monitor statutory changes affecting Medicare and Medicaid programs as soon as they occur; and know the intricacies of program rules and subregulatory guidance to help you achieve your business and strategic goals.

We help providers achieve favorable Medicare and Medicaid reimbursement and coverage policies; protect against negative regulatory policy changes; and stay compliant under program guidelines, including the Anti-Kickback Statute, the Emergency Medical Treatment and Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA).

Our Healthcare Practice attorneys have a three-pronged approach in representing our clients: 
  • We know their business. We have represented providers across the health care spectrum.
  • We know the law and the regulations. They are constantly changing and we work with them every day.
  • We know and work with the policy-makers. We understand how the relevant regulatory agencies work, the right people to approach, and the best arguments to make to achieve our clients’ goals.

Areas of Focus

Our attorneys regularly represent clients across the healthcare provider spectrum, including:
  • Individual hospitals and large healthcare systems
  • Physician practice groups
  • Accountable care organizations
  • Dialysis providers
  • Long-term care facilities
  • Home health agencies
  • Nursing facilities
  • Freestanding psychiatric and rehabilitation hospitals
  • Federally qualified health centers
  • Pharmacies
  • Pharmaceutical distributors
  • State and national trade associations representing these providers

Experience

  • Advising hospitals on CMS site-neutrality policies, including compliance with the Medicare program’s “provider-based” billing requirements.
  • Convincing CMS and a state Medicaid agency that a residential treatment facility was not an institution for mental disease, thereby allowing Medicaid payment for inpatient hospital services provided at the facility to continue uninterrupted.
  • Successfully advocating for appropriate disproportionate share (DSH) hospital payment policies as Medicare transitioned to a new payment formula mandated by the Affordable Care Act. On behalf of a client, we convinced CMS that it should tweak the factor in its payment formula that recognizes hospital uncompensated care.
  • We have helped hospitals persuade CMS that it should revise national policies governing Medicare’s hospital area wage index to achieve proper recognition of hospital labor costs.
  • We advocated for dialysis facilities as Medicare shifted to a new bundled payment system to treat patients with kidney disease. We also advise dialysis facilities on Medicare and Medicaid secondary payer policies.
  • We advised a large national home care company as Medicare revised the home health prospective payment system and advocated for the company before CMS as it implemented the new payment policies.
  • As Medicare encountered increasing problems with its competitive bidding program for the home medical equipment industry, we advocated on behalf of the industry for a program freeze as the agency moves to a new bidding structure for “Round 3” of the program.
  • We have helped hospitals remain compliant with EMTALA program rules and have represented hospitals in EMTALA investigations by the Department of Health and Human Services Office of Inspector General.

News & Insights

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Our attorneys share their points of view on Medicare and Medicaid reimbursement for providers matters.