Legal Counsel For Medicare And Medicaid Reimbursement In Michigan

Your revenue cycle hinges entirely on accurately understanding the rules of Medicare, Medicaid and private third-party payers. In these cases, even minor errors can trigger audits, massive recoupment demands and debilitating False Claims Act liability.

At Ottenwess Law, we provide critical guidance to a diverse array of health care clients in Michigan. To improve billing practices to consistently comply with regulatory standards and advocate for these health care providers to resolve reimbursement disputes with federal agencies or third-party payers.

Medicaid And Medicare Support

Our legal services are structured around the three primary sources of health care reimbursement:

• Medicare: We provide comprehensive counsel on Medicare coverage, documentation and payment rules. This includes auditing billing practices, advising on participation agreements and aggressively representing providers in audits and payment appeals.
• Medicaid: Our firm helps clients comply with the varied and complex regulations of state-specific Medicaid programs. We assist with eligibility and enrollment issues, advise on state-mandated fee structures and defend against Medicaid fraud and abuse investigations.
• Third-party reimbursement: We offer strategic support for dealing with commercial insurance companies. This involves reviewing and negotiating favorable payer contracts, managing disputes over payment rates and coverage and handling litigation-related demands.

By compartmentalizing our expertise into these three crucial areas, we deliver targeted, effective solutions that protect your revenue cycle from both regulatory scrutiny and contractual disputes.

Experienced Attorneys Helping Health Care Professionals In Michigan

Our health care attorneys assist with the resolution of all reimbursement-related disputes with the Centers for Medicare and Medicaid Services (CMS), including payment disputes involving RACs (recovery audit contractors) and MACs (Medicare administrative contractors).

We also pursue remedies for billing disputes with third-party payers such as Blue Cross/Blue Shield, HMOs and other private insurers. Typically, our clients have provided services that are covered under the plan, but payment has been denied on the basis of:

• Improper billing – Overbilling, unbundling, lack of medical necessity, etc.
• Enrollment – MAC determines if the entity is not enrolled correctly or credentialed
• Credentialing – The physician lacks privileges or proper licensing

Using more than 150 combined years of experience, we guide our clients through the administrative process and convince CMS or third-party insurers to authorize payment. If necessary, we assist with timely appeals of disallowance, such as denial of claims challenges. If there is no way to resolve the conflict through the appeals process, our lawyers will provide representation in court.

Why Work With Us

Our legal services are designed to help health care organizations optimize revenue while mitigating the severe risks associated with government oversight and payer scrutiny. Our firm provides targeted legal support across the entire reimbursement cycle, including:

• Risk mitigation: By establishing rigorous compliance programs, a lawyer proactively identifies and corrects weaknesses in billing practices, significantly reducing the likelihood of costly audits, penalties or litigation.
• Optimized revenue: We ensure you are maximizing legitimate reimbursement by accurately interpreting complex coverage rules and successfully appealing unwarranted denials, protecting your bottom line.
• Comprehensive advocacy: In high-stakes disputes, lawyers provide the necessary legal support to challenge sophisticated government and payer legal teams.

Our team of experienced lawyers can provide a powerful defense that protects your professional reputation and financial viability.

Get Comprehensive Legal Support From Experienced Medicare And Medicaid Reimbursement Attorneys

Ottenwess Law routinely litigates and resolves billing disputes. Contact us today to arrange a free initial consultation with one of our Michigan Medicare and Medicaid reimbursement attorneys by calling 313-965-2121 or filling out our online contact form.