Michigan Medicare And Medicaid Reimbursement Attorneys

Obtaining proper payment for services rendered can be an ongoing battle. The law firm of Ottenwess Law, provides critical guidance to healthcare providers to improve billing practices in order to consistently comply with regulatory standards. We also advocate for these healthcare providers to resolve reimbursement disputes with federal agencies or with third-party payers. Our intervention often results in settlements, but we have litigated dozens of these matters when administrative appeals are exhausted.

We represent a diverse array of healthcare clients in Michigan and nationwide, from regional medical centers to small hospitals, physician groups, individual practitioners, behavioral health entities, emergency medical services companies and home health agencies. Our lawyers excel at resolving enrollment and credentialing disputes to expedite payment to our clients.

CMS Billing Disputes And Third-Party Payer Reimbursement

We provide expert representation in reimbursement 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.

Our healthcare attorneys assist with resolution of all reimbursement-related disputes. Typically, our client has 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 the entity is not properly enrolled or credentialed
  • Credentialing — the physician lacks privileges or proper licensing

Our experience and extensive knowledge of the complex payment systems allows our attorneys to effectively guide clients through the required administrative process to convince CMS or third-party insurers to authorize payment and, if necessary, to help with timely appeals of disallowance, such as denial of claims challenges. If the conflict cannot be amicably resolved through the formal appeals process, clients are represented by skilled trial lawyers.

Healthcare Law Attorneys Representing Providers

Ottenwess Law, routinely resolves and litigates billing disputes. Contact us today to arrange a consultation with one of our Michigan Medicare and Medicaid reimbursement attorneys.