PAYOR DISPUTES

 

strategic and technical expertise

Polsinelli Heath Care Solutions provides strategic solutions to Healthcare providers facing federal, state and commercial payor audits encompassing statistical analysis, coding support with professional partners and management of e-document solutions to minimize costs and expedite the resolution of payment disputes. Our advisors have experience with the alphabet soup of claims review contractors and auditors (i.e., ZPIC, SMRC, CERT, RAC and others). Because public and commercial payor contract auditors are incentivized to deny claims for improper payments, providers must be well-positioned to appeal incorrectly-denied claims.

Our work spans from multi-site health systems to durable medical equipment suppliers. We also provide reimbursement analysis and strategy support to resolve audit questions early and avoid unnecessary recoupments. Advisors on our team lean upon their vast litigation experiences and insider knowledge of the industry to streamline dispute resolution.

 
GettyImages-816332598.jpg
 

PAYOR DISPUTE Solutions

Our payor dispute consulting involves a collaborative process involving coinciding phases and processes, including:

  • Payor dispute strategy development

  • Strategy implementation including sharing of work-product to efficiently and effectively develop audit appeal letters and provide training of client staff

  • Positioning internal team members to assume primary responsibility for preparing initial appeals with periodic review and advisor oversight, thereby migrating to an appeals advisor role

  • Conducting Medicare and Medicaid reimbursement analysis and appeal strategy support, including meetings with CMS and MACs throughout the United States

  • Preparing appeals for administrative hearings and beyond, including witness preparation

  • Providing other support for formal and informal appeals and resolution of provider-payer disputes