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About Billing and Payment

The billing and payment section works with clients to establish and maintain Medicare and Medicaid compliant billing practices. We evaluate and assess the reimbursement implications of various organizational and operational structures. We believe we provide the best value when clients consult us in the planning stages of business ventures or restructuring, to ensure that billing and payment requirements are factored into the decision process and that all options are considered. We maintain relationships with representatives of intermediaries, carriers, and state and federal regulatory agencies, which we regularly consult on behalf of clients, to obtain formal or informal opinions on billing and payment matters.

We regularly work on the coverage and billing requirements necessary to establish payment in many types of provider settings. Examples of projects include: program enrollment (Form 855A); provider-based applications and planning; analysis of bundling/unbundling issues, such as DRG payment window and consolidated billing restrictions; and appeals of government reimbursement determinations, including PRRB appeals, Part A and Part B administrative appeals, and appeals of Medicaid recoupments. We also provide assistance in obtaining or maintaining classification as sole community hospitals, rural referral centers, small Medicare dependent rural hospitals, critical access hospitals, and excluded units.

We also work extensively with the coverage and billing requirements necessary to establish payment in various types of supplier settings.

Examples of projects include: analysis of enrollment options; consideration of incident to and supervision requirements; obtaining provider-specific guidance on laboratory billing and purchased diagnostic test issues; and assistance with program enrollment (Form 855B).