The Martin Law Firm
A Professional Corporation
Area of Practice – Health Care Law
Introduction
Health care providers are facing more and more challenges from the insurance industry. Typical challenges include compliance, retrospective reviews/audits, recoupment, fraud claims, and denials. The Martin Law Firm takes a strong initiative in helping the providers successfully overcome these obstacles so that the provider can focus the energies on quality patient care and maximizing profits.
Retrospective Reviews/Audits
Recently, health care providers, especially chiropractors, are experiencing an increase in retrospective reviews/audits leading to significant overpayment demands from the insurance industry. Proper handling of these matters takes a thorough understanding of federal and state insurance laws, coding guidelines, documentation and attention to detail. Achieving the desired result also takes experience and professionalism in communicating the position of the provider to the insurance or Medicare representatives. The Martin Law Firm has saved providers hundreds of thousands of dollars in overpayment demands.
Compliance Program
The Department of Health and Human Services' Office of Inspector General has provided compliance program guidance to assist health care providers in adhering to applicable statutes, regulations and program requirements. It is well established that health care practices implement and maintain a compliance program in an effort to identify and correct risk areas regarding billing, coding and documentation. In addition, the Compliance Program will serve as an educational tool for the provider and his/her employees with regards to fraud and abuse laws.
An effective compliance program will mitigate risk exposure and serve as protection for the provider against the insurance industry and federal programs such as Medicare.
HOUSE BILL 2178 – "The Recoupment Bill"
Many announcements have been made recently with the push to have House Bill 2178 signed into law. A wide perception is that the Bill will significantly reduce the amount of retrospective reviews/audit since it provides a 12 month limit for insurance carriers to retrospectively review claims and records. However, the Bill, as currently written, provides two exceptions to this 12 month look back rule that could be more problematic for the provider. The two exceptions are Fraud and Improper Coding. Other states have enacted similar statutes and the amount of reviews/audits has not decreased. Therefore, individual practices should be more inclined to proactively implement a Compliance Program in preparation for continued reviews/audits despite the potential passage of HB 2178.
Open Letter to Chiropractors
The Martin Law Firm has commenced un-paralleled legal research projects with the assistance of ProviderPRO.net (www.providerpro.net) which will help serve the interests of the health care provider. The items are briefly discussed in the following open letters:
Licensure, Certification and Disciplinary Representation
Criminal and Civil Representation
Defending against claims of fraud and violations of false claims, kickbacks, civil monetary penalties, and Stark.