Medicare, Medicaid, and Reimbursement
Protect Healthcare Revenues with Legal Services from Wise Carter
Revenue is the lifeblood of a business, including those in the healthcare space.
At Wise Carter, we understand the specific legal and regulatory challenges healthcare providers face in managing their revenue cycles due to the unique combination of third party payer systems. These are often dominated by federal and state bureaucracies — an overlay of complex regulations that affect not only how, when, and how much revenue can be collected but also the structure of relationships between healthcare entities and their strategic partners and service providers.
Wise Carter lawyers follow these dynamic and ever-changing rules and their impact on compliance, contracting, and internal compensation plans, as well as on revenue cycle management.
Maximizing revenue in a compliant manner requires a legal team that is knowledgeable and experienced with payer rules and regulations and is equipped and prepared to fight when disputes with payers arise.
Wise Carter’s Medicare, Medicaid, and Reimbursement Services
Wise Carter health lawyers have the knowledge and experience these challenges demand. We provide counsel on guidelines for participation in Medicare, Medicaid and other third party payer plans, including proper billing practices, medical necessity policies and other areas to help clients receive proper payment for claims.
We also assist clients with provider enrollment, credentialing and revalidation issues and assist with day to day client questions related to billing and participation with various third-party payers.
We help clients understand and take advantage of special payment programs that allow increased reimbursement for services provided in medically underserved areas and other regions based on factors such as patient population and income level.
Wise Carter assists clients with the issues that arise as payers continue to move from the traditional fee for service model to reimbursement based on risk sharing, quality, and performance-based reimbursement.
Our health lawyers counsel clients in the creation, governance and management of accountable care organizations (including those in the Medicare shared savings program) and bundled payment initiatives and programs (including downstream contracting among the providers in the bundled payment group.)
Wise Carter’s Experience
Due to the complexity of the rules and the leverage of large third party payer systems, conflict between healthcare providers and the payer plans of their patients inevitably arise.
For decades, Wise Carter’s healthcare lawyers have represented hospitals, nursing homes, physician groups and other healthcare providers in disputes with Medicare, Medicaid and private payers.
These disputes demand counsel that not only has knowledge of the complex regulatory work of healthcare reimbursement but also the trial skills to examine witnesses in adversarial hearings and the litigation experience to obtain judicial relief when necessary.
Wise Carter successfully represents hospitals and other providers from the administrative level through appeals to the highest levels in federal and state court.
Our attorneys stay abreast of the changing laws through regular continuing education and daily real-life experiences. Wise Carter lawyers have handled the full spectrum of payer disputes from payer recoupment demands to small physician groups to statewide Medicaid litigation with literally billions of dollars at stake.
We have litigated and prevailed in Medicare and Medicaid appeals, PRRB appeals, network participation disputes and reimbursement disputes with private MCOs and insurers. Some specific examples include:
- Litigation to declare unconstitutional the 2005 Mississippi hospital tax imposed by the Division of Medicaid.
- A suit challenging CMS’s interpretation of disproportionate share hospital (DSH) payment rules.
- A suit to require the Division of Medicaid to implement the Mississippi Hospital Access Payment program.
- A judicial challenge to the Mississippi Medicaid managed care contract awards.
We have handled numerous Medicaid and Medicare appeals and reimbursement litigation against private payers. Wise Carter successfully represents hospitals and other providers from the administrative level through appeals to the highest levels in federal and state court.
Contact Wise Carter
For legal assistance for Medicare, Medicaid, and Reimbursement issues, please contact one of the Wise Carter attorneys below.