• Experienced at all levels of Medicare administrative appeal procedures, including Medicare administrative contractor (“MAC”) /regional home health intermediary (“RHHI”) “redeterminations”, qualified independent contractor (“QIC”) reconsideration appeals, and office of Medicare hearings and appeals (“Omha”) administrative law judge (“ALJ”) hearings and appeals
  

• Assertion of Medicare advantage (“MA”) plan “private contract” claims appeal procedures
  

• Advocacy during pre-payment review audits

• Defense and appeal of Medicare and Medicaid post-payment review audits, including appeal of overpayment sampling audits and extrapolations determining overpayments

• Review of Medicare national coverage determination and local coverage determination issues

• Review of Medicaid handbook coverage issues

• Primary/secondary payer issues involving Medicare, Medicaid, group health and private insurance, workers’ compensation coverage, and personal injury liability coverage and liens

• Private payer coverage analysis and claims appeals

• Prompt payment laws and remedies

• Documentation of delivery of services, medical necessity for covered services, authorization for services, service supervision requirements, and billing and collection efforts

• Analysis of complex payment issues-including stark law self-referral issues, Florida patient self-referral act issues, state and federal antikickback issues,  fee-splitting prohibitions, and “balance billing” prohibitions
  

HOW WE WORK WITH HEALTH CARE PROVIDERS AND PROFESSIONALS ON PAYMENT ISSUES

When payment or audit issues arise for our clients, we have the depth of experience necessary to work closely with your billing and administrative staff to act promptly and decisively to assert and protect your payment and appeal rights and remedies. We are credentialed and experienced as health care counsel to take those actions necessary to collect and retain the payments for services which our clients are due.

PAYMENT AND AUDIT AREAS WE COVER

MAIN OFFICE: (407) 347-9988  fax: (407) 347-9989 

        Tracy

Mabry Law, P.A.

THE PROVIDERS' HEALTH CARE COUNSEL

PROTECTING AND ADVOCATING FOR YOUR RIGHT TO PAYMENT FOR HEALTH CARE ITEMS AND SERVICES

TODAY’S HEALTH CARE SYSTEM GOVERNING PAYMENT FOR SERVICES AND AUDIT OF CLAIMS FOR PAYMENT IS COMPLEX. SECURING AND RETAINING FAIR PAYMENT FOR SERVICES RENDERED SHOULD NEVER BE TAKEN FOR GRANTED. WE KNOW THAT A MATERIAL DISRUPTION OF PAYMENTS DUE FROM JUST ONE PAYER CAN SOMETIMES THROW OUR PROVIDER AND PROFESSIONAL CLIENTS INTO “SURVIVAL MODE”.  

Billing Problems and Claim Denials

​We're on Your Side

Please contact Tracy Mabry Law, P.A. for a free initial consultation. Experienced representation is just a phone call away.

Resolving Health Care Billing Problems FL