Coverage & Reimbursement
Medicare, Medicaid and other Federal health care programs are the largest purchasers of health care services in the United States, and, as such, the ability to advise health care organizations regarding coverage and reimbursement under these programs is essential. Members of Sonnenschein’s Health Care Practice Group have extensive experience advising hospitals, nursing homes, physicians, ancillary service providers and other health care organizations regarding all aspects of government-payor coverage, coding and payment. For example:
- Sonnenschein attorneys provides reimbursement advice on a wide range of issues, such as provider-based status, change of ownership, coverage for investigational devices, graduate medical education, and disproportionate share payments.
- Our attorneys assist clients in challenging the reimbursement decisions made by Medicare fiscal intermediaries and carriers, and we have extensive experience representing providers before the Provider Reimbursement Review Board as well as physicians and other suppliers in Medicare Part B administrative appeals. Sonnenschein lawyers handle Medicare reimbursement appeals in nearly every judicial circuit in the country, as well.
- In addition, we help clients navigate the certification and decertification processes under the Medicare and Medicaid programs. This includes advising clients as to the Federal “conditions of participation” necessary to qualify as a particular type of provider, such as a hospital, long-term care provider, ambulatory surgery center, or independent diagnostic testing facility.
- Sonnenschein regularly assists clients seeking to meet specific certification and/or classification requirements, such as PPS-exempt units or hospitals, “hospital-within-a-hospital” arrangements, and “under arrangement” relationships that involve the provision of services to Medicare beneficiaries.
