Focused On Health Care Law

Protecting Providers In Medicare, Medicaid And Private Payer Audits And Appeals

At some point, nearly every health care provider, from solo practitioners to group practices, will face Medicare, Medicaid, or private insurance audits of services and payments. These audits are undertaken by a variety of organizations that scrutinize all aspects of billed services, including medical records and billing records, often resulting in overpayments.

Regardless of the type of audit, you will benefit from having a lawyer with experience in these often-complex cases guiding you through the process and defending any demands for repayment. At Williamson Health Law, we have extensive experience advising health care providers in the appeals process.

Guidance In Medicare And Medicaid Appeals

We handle state-specific appeal cases across Michigan, and we handle Medicare appeals for clients nationwide. Our firm is prepared to assist you at any stage of the appeals process.

Simply because a private payer audit concludes that overpayments were made does not mean that this is accurate or reflective of the specific facts in your case. We will help you analyze the results of an audit, the impact those results can have on your business and your options for appealing the results.

Private Payer Audits And Appeals

As with Medicare and Medicaid audits, we are prepared to assist you at all stages of the audit and appeal process involving private payers. We often defend physicians and their practices against allegations regarding lack of documentation or medical necessity. We know the negative impact a private payer audit can have on your business. Our attorneys can guide you in appealing these decisions and argue that the results were incorrect.

Appeals Of Disaffiliation And Departicipation

When a payer decides to disaffiliate or departicipate a provider after an audit, it can have a serious negative effect on the practice. We assist clients with appealing disaffiliation and participation termination.

In addition, we offer our clients a wide range of tailored services, including compliance with and interpretation of Medicare, Medicaid, Blue Cross Blue Shield and other payer rules and regulations.

Learn More About Audits And Appeals

We are here to provide you with the information you need to understand the audit process as well as your ability to appeal the results. To discuss your questions and concerns directly with a member of our esteemed legal team during a consultation, call Deborah Williamson at 734-789-7948 or contact us online.