Healthcare

 

Healthcare Law Practice

Healthcare is and will continue to be one of the biggest, most regulated and increasingly complex industries in our nation.  As the government focuses on reducing and controlling health-care spending, healthcare providers are increasingly facing audits, investigations and litigation over their everyday actions.  Maintaining compliance with state and federal regulations

 

is not only good practice, it is the law.  Providers however are finding that compliance is often not enough.  Today, providers must adopt a defensive position and prepare for the inevitable scrutiny of their practices. 

Our experience, expertise and in-depth knowledge of the current regulatory issues facing healthcare providers allows us to provide comprehensive advice to our healthcare clients. 

Compliance Plans

Assisting clients in developing policies, procedures and processes to comply with federal laws regarding the development and maintenance of compliance plans. Rather than take a premade plan off the shelf, Siddel Law creates a plan to meet the provider situation, resources and business objectives.

EMTALA Issues

Representing healthcare providers in ensuring compliance, investigating and responding to alleged violations of the Federal Emergency Medical Treatment and Labor act (EMTALA)

Managed Care Contracting

Drawing upon our extensive experience in negotiating, designing and measuring the impact of managed care contracts with third-party payers, we will advise you on how to best to reach your objectives.  We assist providers with the review and assessment of compliance to the terms of existing contracts.

HIPAA, Privacy and Security

Assisting healthcare clients comply with medical information privacy and security requirements that are mandated by state and federal law including the Health Insurance Portability and Accountability Act. (HIPAA)

Regulatory and Governmental Compliance

Assisting healthcare providers in responding to governmental audits and investigations including those related to claims under state and federal claims acts. 

Billing and Reimbursement

Advising healthcare providers on issues impacting the full revenue cycle including reimbursement from Medicare, Medicaid/Medi-Cal and other private third-party payers.

Charge Master Litigation Defense

Siddel Law has the expertise to represent providers in all instances where charges are challenged as being unreasonable or other issues with the charge description master.  Our experience with the required coding, compliance for charge structure and marketplace pricing makes us a leader in this area.

Fraud and Abuse

Our experience allows us to provide our healthcare clients with advice during audits and investigations whether you are dealing with the Department of Justice (DOJ), Office of the Inspector General (OIG), Health Care Fraud Prevention and Enforcement Team (HEAT), or for the federal Bureau of investigation (FBI).

Private Payor Audits

It is not unusual for providers to be faced with a payor who has completed a retrospective audit and now seeks return of millions of dollars from previous payments.  These audits often hinge on the interpretation of a contract term, a coding nuance or billing guidelines that govern the relationship between the provider and payer.  We can assist you in successfully defending these audits and claim denials.

RAC Audits

Recovery Audit Contractors (RAC) contract with the Centers for Medicare and Medicaid (CMS) services to identify overpayments and underpayments made to providers for services billed to the Medicare program.  The RAC contractors are paid on a contingency fee and there`s no penalty for attempting to collect for services that were reimbursed correctly to the provider.  For this reason it is important that each provider have an ongoing process to manage, analyze, and appeal RAC audits.  Our experience in this area can help you minimize the cost associated with these audits are adapting your practices to prevent future audits.

ZPIC Audits

Zone Program Integrity Contractors (ZPIC) and program safeguard contractors are the contractors that are responsible for the implementation of the Medicare benefit integrity program.  While this program is in the early stages, its potential impact on providers is expanding.  Preparing today for defense of these audits will help prevent revenue losses tomorrow.

CERT Audits

The Comprehensive Error Rate Testing (CERT) program is designed to determine the underlying reasons for claim errors and develop action plans to improve compliance with payment claims processing and provider billing requirements.  The Medicare Administrative Contractors (MAC) often look to the results from the search program to determine future audits and the focus of investigations. Providers must conduct internal investigations to ensure the issues identified by the CERT are not impacting their business.

Denial Management and Prevention Strategies

Providers are often frustrated, after providing top-notch services to patients as prescribed by their physician, only to find the payer denying payment for these services retrospectively.   Understanding the underlying causes and strategies in use by payers to deny claims and the development of action plans to prevent future denials is essential to all providers` survival.

Internal Compliance Investigations

Our experience with the development with internal, ongoing compliance audit programs has helped providers identify weaknesses and compliance risk areas throughout their organization.  Providers face a stark choice; either invest in internal well-designed compliance audit programs today or risk public disclosure of their mistakes in the future.

Program Effectiveness Assessment

Providers that have developed internal compliance departments and programs should conduct an independent annual review of the effectiveness of these programs.  Our experience with compliance programs makes us the perfect partner to complete the effectiveness assessment.

Interim Legal/Compliance Officer

The Federal/State rules and laws governing healthcare providers today are constantly changing.  It is essential for providers to have consistent and strong direction in the legal and compliance departments to ensure full compliance with all laws.  When personnel changes occur providers can often find themselves without leadership.  We can help by serving as an interim compliance officer or legal counsel.

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