Five Provider Options for Medicare and Medicaid Appeals and Audits

By guest blogger Libby Burke


It’s no secret that audits by Medicare and Medicaid contractors are on the rise and at an increasing rate. What started as a “demonstration” by the Federal government has evolved into a very costly and confusing program that continues to burden health care provider resources.

Health care providers generally respond to Medicare audits in five primary ways:

  1. Utilizing internal clinical staff
  2. Utilizing in-house attorneys
  3. Outsourcing to clinicians
  4. Outsourcing to law firms
  5. Outsourcing to a legal services provider (newest option)

Let’s dig a little deeper into these five options:

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DS5.0 Takeaways: Process is Still King

Last week we had approximately 50 of our discovery clients and colleagues in Nashville for Counsel On Call’s annual Discovery Symposium. It was a brief but content-rich event where 75 of the brightest, on-the-ground in-house counsel, discovery managers and IT leaders met to discuss challenges they’re facing and how they’re addressing them. You can see the agenda here.

We all learn so much every time this group assembles, and 2013 was no different. We dove into the mechanics of predictive coding and machine-based learning, the cloud and its discovery and technology challenges, proportionality, chain of custody, information governance, and a host of other topics that were widely (and productively) debated. But the one subject that stood out more than the others was the continued focus on process.

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Discovery Symposium 5.0

It’s Discovery Symposium week here at Counsel On Call, which is one of our favorite times of the year. We invite many of our clients and e-discovery managers to Nashville for 24 hours of high-level programming, with plenty of fun mixed in.

It’s hard to believe this is our fifth year hosting the event. The symposium has grown from a dedicated group of 40 clients in 2009, who wanted to speak candidly about discovery issues to a larger event capped at 75 people this year. The goal has always been to foster open dialogue about practical issues and to identify best practices. We’ve found throughout the years that to accomplish this we couldn’t allow the group to get too large.

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Lessons Learned at the University of Florida Law/EDRM Conference

Post by guest blogger Tiffany Fox

I had the opportunity to attend the inaugural E-Discovery for the Small and Medium Case conference at the Levin College of Law at the University of Florida (UF) in the beginning of April. This was an effort by UF to educate attorneys who may not have had exposure to the world of ESI, typically because their cases don’t involve the large corporations who have been doing e-discovery for years. The purpose of the conference was to identify and explain best techniques in approaching e-discovery in smaller cases (for example, divorce or employment matters), but the net effect was a solid overview of the world of e-discovery.

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