Understanding the nuances of Medicare and Medicaid reimbursement is one of the greatest challenges that providers face in today’s quickly changing health care world. The reimbursement process can be long and arduous, and can change often, as described in this quote:

"There can be no doubt but that the statutes and provisions in question, involving the financing of Medicare and Medicaid, are among the most completely impenetrable texts within human experience. Indeed, one approaches them at the level of specificity herein demanded with dread, for not only are they dense reading of the most tortuous kind, but Congress also revisits the area frequently, generously cutting and pruning in the process and making any solid grasp of the matters addressed merely a passing phase."

— Rehab. Ass'n of Va. v. Kozlowski, 42 F.3d 1444, 1450 (4th Cir.1994).

Reimbursement is driving the current evolution of health care and the inability of some providers to understand or take advantage of these changes may threaten their very existence. Polsinelli boasts one of the largest health care reimbursement groups in the country with strong experience in all areas of reimbursement. From understanding byzantine coverage requirements to handling the most complex audits, our team regularly assists providers in making sense out of one of the most convoluted areas of health care. Our experience includes:
  • Assistance with responding to and appealing audits (e.g., Medicaid, Medicare, ZPIC, and RAC);
  • Strategic advice on clinical alignment, pay for quality and bundled payments;
  • Assistance with analyzing and reporting overpayments;
  • Counseling on Provider Based Billing;
  • Counseling on DSH qualifications;
  • PRRB Appeals;
  • Prepayment Reviews;
  • GME Reimbursement Compliance;
  • Medicaid Managed Care and Dual Eligible Managed Care Programs; and
  • 340B Compliance.
Our team includes the former Deputy Director of Colorado’s Medicaid agency, former OIG counsel, multiple former Assistant U.S. Attorneys with experience in health care fraud, former in-house counsel, a licensed CPA attorney who served as an in house accountant for a hospital, several former consultants. Our team is familiar with all of the various administrative appellate venues and regularly works with CMS to resolve complex reimbursement issues. We also have a strong Public Policy team that intimately understands health care reimbursement issues and works with our clients in pursuing legislative strategies to address their most pressing reimbursement needs.

Polsinelli's Reimbursement Institute (www.polsinelliri.com) was created in an effort to continuously track changes within the industry as well as analyze the implications of those changes more easily and effectively. In providing a single source of news, information and other resources, the Reimbursement Institute is intended to serve as a valuable reference to Polsinelli clients as they navigate the channels of Medicare and Medicaid reimbursement.