Understandably, one of the issues that is most important to healthcare providers is payment. However, there is probably no business that has a more complicated payment scheme than healthcare among the complicated and sometimes conflicting requirements of Medicare, Medicaid, Blue Cross, commercial insurers, HMOs, and other managed care organizations.

We understand how critical it is that our clients get timely payment, and we work hard and cooperatively with clients to resolve difficult questions concerning payment. We are not a billing service and do not advise clients on routine coding or billing format, nor do we do the actual billing audits, all of which are better handled by vendors of those services. Nevertheless, we provide clients very substantial support, sometimes in conjunction with other consultants, on difficult billing-related legal issues, including but not limited to:

- provider reassignment requirements

- “incident to” payment

- physician supervision requirements

- “bundling” issues

- management of overpayment situations

- structuring of compliance audits

- payor audits and repayment arrangements.

Healthcare Payment