Appeals Practice

The Centers for Medicare and Medicaid Services recently promulgated new regulatory provisions governing the Provider Reimbursement Review Board. For those of you who have had an opportunity to review the new regulations, it should be apparent that these revisions are far reaching and signal a fundamental shift away from the current adjudication procedures.

"In today's ever changing economic environment, protecting your appeal rights is paramount. CMS has clearly created an environment that lends itself to confusion with the potential for lost revenue. CampbellWilson's Appeals Group offers a unique team approach that combines both the technical and financial expertise necessary to protect your reimbursement rights and recover lost revenue." —Pat McCaa, Vice President of Appeals

As the new rules also state, there are a few "mile marker" deadlines/requirements that could have a significant impact on your future reimbursement. Probably the most significant and far-reaching change involves the interaction between the cost report preparation and future appeals. As the new rules mandate for all cost reports filed on or after December 31, 2008, providers will be required to identify all potentially appealable issues by either "self-disallowing" or protesting contested items. Failure to do so will result in the provider being precluded from appealing these issues when the Notice of Program Reimbursement is issued.

CampbellWilson, LLP has worked with a number of providers throughout the country helping them develop a better understanding of the interaction between the cost report and the subsequent appeal and are able to offer you the same level of expertise.

Our appeals group can assist you with the following:

• Identification and calculation of financial impacts for appealable issues.
• Filing of Individual/Group appeals.
• Joint Scheduling Order negotiation and preparation.
• Position Paper preparation.
• Conducting Live/Recorded/Telephonic Hearings.
• Administrative Resolution negotiation and preparation.

CampbellWilson Medicare/Medicaid expertise areas include the following:

• Bad Debt, DSH / SSI, TEFRA, GME/IME, ESRD, & SDA
• Excessive Borrowing
• Decertifications
• Post Acute Transfer Review
• Any other provider cost report dispute

For more information, contact us at 800.723.6492 to speak to one of our experienced consultants or email us for more information: info@campbellwilson.com.

15770 North Dallas Parkway, Suite 500, Dallas, TX 75248 | 214.373.7077 | Toll Free: 800.723.6492