Manufacturers, Suppliers and Laboratories

Parrish Law Offices represents a diversity of device, diagnostic, and therapeutic companies, including durable medical equipment suppliers, independent diagnostic testing facilities, and manufacturers of technologies used in medical treatments ranging from surgical tool kits to dialysis supplies.

Addressing Claims Denials

According to government reports, only 2.5% of denied Medicare Part B claims are appealed, even though more than 50% of appeals are successful. Winning appeals can be necessary for companies bringing new technologies to market – where payers may classify technologies as “experimental and investigational,” and therefore non-covered, or covered but reimbursed at levels insufficient to allow the technologies’ dissemination – and to companies with high dollar or high volume services.

We are one of the top filers of appeals before the Office of Medicare Hearings and Appeals (“OMHA”); we have participated in more than 1,000 cases. Through these appeals, we have succeeded in (1) recovering reimbursement on previously-denied claims, and (2) establishing favorable claims treatment going forward, thus ending the need for further appeals.

Challenging Payer Coverage Policies

Medicare, Medicaid, and private payer coverage generally varies depending on the geographical area involved. Payer coverage policies advise providers and practitioners when particular items and services will be considered reasonable and necessary, and when coverage is available. They can be issued to assure beneficiary access to care; often, they are issued when payers address high dollar or high volume services, and/or anticipate frequent claims denials.

We are one of the top filers of challenges to non-coverage policies. We have counseled numerous manufacturers, suppliers, and laboratory clients on Medicare Local Coverage Decision reconsideration requests, and we have filed a number of LCD challenges in multiple geographic areas for non-coverage LCDs. Many of these have resulted in successful revisions of non-coverage LCDs.

Resolving Audit Matters

Companies increasingly are facing both pre-payment and post-payment audit issues. Auditors may undertake “probe,” or similar, audits of a limited number of claims and, as a result, both freeze the payment of new claims and seek return of alleged past overpayments.

We have expertise in handling public and private payers audits, including RAC, ZPIC, CERT, and Benefit Integrity audits. We use our extensive experience handling OMHA and additional administrative/agency appeals and, where it makes sense, we also use negotiations to – again – both successfully resolve current audits and minimize audit issues going forward.

Designing Overall Reimbursement Strategies

Designing “front-end” reimbursement strategies can be especially critical for companies with new technologies. They face decisions whether to proceed under existing codes or to seek new codes; they face critical issues when payers deem products or services to be “experimental and investigational” and place them under “miscellaneous” or “T” codes.

We specialize in working with providers regarding new medical technologies just entering the marketplace. We help companies, as part of product and service development processes, to develop coding, coverage, and payment strategies to minimize the need to undertake claims appeals and coverage challenges, and/or to help providers plan for and overcome the obstacles that often confront the introduction of medical innovations.

Facilitating Clinical Studies and Research Efforts

As Medicare has moved to a “coverage with evidence development” model, we have worked with various institutions on clinical trials and coverage issues, ensuring that appropriate care independent of the trial is covered.