Medicare/Medicaid

Lambeth & Associates has extensive experience in all aspects of Medicare participation and compliance.  Some of the services we provide are listed below:

I. Participation in Medicare/Medicaid

• Advise on selection of provider type or status (e.g., provider-based entity vs. freestanding)
• Obtain licensure and certification, enrollment in Medicare/Medicaid
• Advise on continuing compliance with Conditions of Participation
• Draft required policies and procedures

II. Billing, Reimbursement and Clinical Recordkeeping

• Provide advice on coding issues, professional vs. technical component billing, "incident to" services, purchased diagnostic tests, and billing for non-physician professionals (nurse practitioners and others).
• Analyze medical necessity of type, level and frequency of services, clinical record requirements, homebound status, signature requirements, supporting documentation.
• Respond to focused medical reviews and requests for additional information
• Interpret cost reporting requirements for providers
• Participate in audits and prepare responses to survey deficiencies or proposed audit adjustments
• Appeal interim rates, audit/claims adjustments, and denials
• Negotiate settlements with Fiscal Intermediaries, Carriers and other government representatives on denials, recoupment of overpayments, suspensions and offsets

III. Ongoing Operational Compliance

• Evaluate management and billing arrangements (including reassignment)
• Review provider marketing practices and policies
• Draft and review agreements with physicians and nonphysician practitioners
• Advise regarding HIPAA and State privacy rules, confidentiality, improper uses or disclosure of protected health information
• Troubleshoot and provide inservice education as requested