Medicare and Medicaid Reimbursement and Payment
Our healthcare clients routinely look to us to provide guidance in matters relating to coverage and payment under Medicare, Medicaid, and other federal healthcare programs. Our attorneys have an extensive understanding of both the technical and legal aspects of these programs, as well as a broader insight into the policy underpinnings of these complex legal authorities. Through their years serving clients in the industry, Morgan Lewis attorneys have cultivated respect and recognition within the healthcare reimbursement community and positive relationships with the government officials with whom they frequently interact. Our attorneys use their acumen to solve coverage and payment issues for a wide range of healthcare entities, including hospitals, nursing homes, physicians, ancillary service providers, and other healthcare organizations. At Morgan Lewis, we regularly assist clients with the following:
- Providing practical reimbursement advice on a wide range of issues, such as provider-based status, change of ownership, coverage for investigational devices, and graduate medical education and disproportionate share hospital payments.
- Challenging the reimbursement decisions made by Medicare administrative contractors, fiscal intermediaries, and carriers. Morgan Lewis lawyers have experience representing numerous healthcare entities before the Provider Reimbursement Review Board, as well as before various administrative law judges, and have pursued these types of matters in federal court.
- Navigating the certification and decertification processes under the Medicare and Medicaid programs. This includes advising as to the federal "conditions of participation" necessary to qualify as a particular type of provider or supplier.
- Meeting specific certification and/or classification requirements, such as qualifying as PPS-exempt units or hospitals, "hospital within a hospital" arrangements, and "under arrangement" relationships.
- Working with staff at the Centers for Medicare & Medicaid Services (CMS) seeking guidance on a wide range of issues of importance and advocating for a particular outcome.
- Assisting in the preparation of comments to be submitted in connection with agency rulemaking.
- Determining whether historic interpretation of payor rules complies with the law and regulations and providing legal support for positions where appropriate.
- Drafting "self-disclosure" letters where necessary when an entity has determined that it has received an overpayment.