Medicare Coverage Audits and Appeals

Powers Pyles Sutter & Verville has successfully assisted providers in thousands of coverage appeals resulting from payment denials by Recovery Audit Contractors, Medicare Administrative Contractors, Zone Program Integrity Contractors, and other Medicare auditors.

Powers has an experienced team of attorneys specializing in all aspects of Medicare audits and the administrative appeals process, including Medicare coverage, payment, and demands calculated by extrapolation. The team works with all provider types, including inpatient rehabilitation hospitals and units, acute care hospitals, specialty hospitals, physicians, and other providers. Our services are tailored to the particular needs of each provider and can include any of the following:

  • Proactive compliance measures to limit exposure and prepare for auditing activities;
  • Customized strategies and analysis of legal issues that arise during the appeals process;
  • Guidance in establishing procedures for handling large numbers of audits and claim denials;
  • Creation of appeal “templates” and model letters for the client to use in order to control legal expenses;
  • Review of appeal documents prepared for submission;
  • Hands-on preparation of appeals documents; and
  • Direct representation at administrative law judge hearings and participation in witness preparation sessions with clinical staff.

Powers also represents clients in the federal courts on Medicare coverage matters. The firm has represented hospitals in the U.S. Courts of Appeals in challenges to RAC audit procedures and delays in ALJ decisions.

The team is headed by Peter W. Thomas and Ronald S. Connelly. The team also includes experienced attorneys, such as Christina A. Hughes and Leela Baggett. Please contact either Peter or Ron for further information about the services provided by the firm’s Medicare Audit & Appeals team.

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