Reimbursement

Approved Medical insurance claimParrish Law Offices is among the top law firms in the United States in obtaining and protecting reimbursement revenues for health care providers, including hospitals and health systems; physicians and physician groups; and manufacturers, suppliers, and laboratories. We have expertise working with device, diagnostic, and therapeutic products and services.

We address a comprehensive range of reimbursement matters involving both public (Medicare, Medicaid, Tricare) and private payers.

These matters include:

  • Individual claims appeals, before the Office of Medicare Hearings and Appeals (“OMHA”). We are one of the top filers of appeals before OMHA and 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.
  • Broad challenges to payer coverage policies, for entire states and geographic regions. We are one of the top filers of challenges to Local Coverage Decisions (“LCDs”). Through both formal and informal resolutions to our challenges, we have succeeded in reversing unfavorable coverage policies and in achieving favorable coverage policies for both products and services.
  • Audits, both pre- and post-payment, by public and private payers. We have secured tens of millions of dollars for our clients from payers trying to withhold, or to recover, these revenues. We have experience handling Recovery Audit Contractor (“RAC”) audits; Zone Program Integrity Contractor (“ZPIC”) audits; Comprehensive Error Rate Testing (“CERT”) audits; Benefit Integrity audits; and private payer audits.
  • Design of reimbursement strategies for launching products and services. We have particular expertise in working with providers regarding new medical technologies just entering the marketplace. We help 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.