Nixon Peabody has extensive experience providing reimbursement advice to health care clients in connection with their participation in the Medicare and Medicaid programs. We provide a full range of counseling on cost reporting and billing compliance, revenue enhancement, and transactional structure to hospitals, nursing homes, home health care services, dialysis providers, durable medical equipment suppliers, physicians, and ambulance companies.
We have established excellent working relationships with Medicare fiscal intermediaries and carriers, as well as officials in the regional and central offices of the Center for Medicare and Medicaid Services. We also submit comments on proposed Medicaid and Medicare reimbursement regulations, advocating for rules and statutory interpretations on behalf of our provider clients. Nixon Peabody advises health care providers in connection with cost report preparation, represents providers at audit exit conferences and in state audit hearings and state Medicaid compliance proceedings, prosecutes appeals for individual health care providers and groups of health care providers to the Provider Reimbursement Review Board and in Administrator’s Review and judicial proceedings, and challenges Medicaid and Medicare regulations and statutes.
Medicaid reimbursement services
- Unnecessary borrowing and interest income offset questions
- Discrete costing and cost allocation issues
- PRI/MDS/ case mix audit issues
- Overpayments, underpayments, recoupments, and offsets
- Contract review/negotiation
- Third-party liability recovery programs
- “Medical Necessity” determinations and claims disallowance appeals
- New York Wage Parity Law
- Rate adjustments and exceptions
- Timely claims processing issues
Medicare reimbursement services
- “Incident to” billing rules
- Reassignment rules
- Disproportionate Share Hospitals
- 340B Pharmacy Discount Program qualification
- Direct and indirect graduate medical education expenses
- Provider-based designations
- Specialty Hospital and Specialty Unit reimbursement
- Sole Community Provider status
- Critical Access Hospitals
- Consolidated billing
- Related party rules