Healthcare providers face increasing scrutiny regarding regulatory changes, more than ever before. Receiving notices of alleged overpayments from CMS or other payors can be very stressful. While healthcare providers may be able to handle the appeals process themselves, the process is extremely complex.
At Oberman Law Firm, we understand Medicare appeals, CMS audits and regulatory compliance, thereby guiding healthcare providers through a complex maze of regulations.
Recovery Audit Contractors (RACs) We review Medicare claims in order to detect overpayments and underpayments. Contractors are finanially incentivized to find errors and many operate on a contingency-fee basis. RACs are expanding their scope to include Medicaid and Medicare Advantage claims as well.
Medicare Administrative Contractors (MACs) We handle enrollment, claims processing, and billing error issues. The MACs identify outliers and conduct audits on healthcare providers with high error rates.
Zone Program Integrity Contractors (ZPICs) We combat fraud through proactive measures like pre-payment reviews, and we use data analysis, as well as referrals from other contractors to identify potential fraud.
Medicare’s Targeted Probe and Educate (TPE) We assist healthcare providers with audits regarding unusual billing practices or high error rates. Providers may undergo up to as many as three (3) rounds of reviews, with appeals that are handled through Medicare procedures.
The Comprehensive Error Rate Testing (CERT) We assist providers with programs that assess claim errors in order to improve compliance, as well as review claims randomly. The program may pre-empt MACs audits for MACs of overpayments or underpayments.
We assist providers with the Medicare appeals process regarding redetermination, reconsideration, Administrative Law Judge (ALJ) hearings.
Medicaid appeals processes may vary by state and may also include reviews by Medicaid Integrity Contractors (MICs) and Medicaid RACs.
About Us
Oberman Law Firm represents clients in a wide range of practice areas, including private equity, M&A, healthcare, corporate transactions, intellectual property, data privacy and security, regulatory compliance and governance, cross-border transactions, labor and employment, construction law, litigation, private clients’ services, corporate restructuring, and white-collar and governmental disputes.
As a firm, we offer the highest quality legal advice coupled with extraordinary and tailored service to deliver exceptional results to our clients. Our philosophy is to invest deeply in the brightest legal talent and build dynamic teams that operate at the pinnacle of respective practice areas. We believe in empowering our attorneys, encouraging entrepreneurialism, operating ethically and with integrity, and collaborating to bring the very best to every client engagement. These principles have guided us in building extraordinary and successful long-term partnerships with our clients.
