Areas of Practice

Claim Denials

Due to increased insurer scrutiny of medical claims and increasingly complex payer models, it has become more difficult than ever for healthcare providers to receive timely and fair reimbursement for their services.

The extensive time and effort which is required to dispute denied medical claims leaves providers between a rock and a hard place - they must either write off a claim which should have been paid, thereby losing critical revenue to which they are entitled, or expend significant energy to dispute the denied claim.

At Bull Owen Law, we harness our knowledge of healthcare reimbursement and the administrative appeals process to successfully challenge these claim denials on your behalf. We employ various strategies to secure the payment to which your practice is owed, including:

  • Reviewing the medical records associated to identify any coding or technical errors which prompted the claim’s rejection and to find evidence, where possible, that the underlying goods and services were properly billed;

  • Organizing the facts regarding the underlying clinical care and documentation related to each denied claim to author a persuasive narrative explaining why the claims should be fully or partially reimbursed;

  • Correcting and resubmitting any claims that the payor denied on technical grounds.

  • Filing an appeal with the payor to dispute the grounds for the claim denials and, if necessary, appeal the adverse decision to the relevant administrative agency and/or state or federal court.

Audits, Reviews, and Recoupments

We negotiate directly with insurers to remove providers from prepayment reviews, dispute the merits of post-payment reviews, and eliminate or minimize a provider’s liability under a recoupment action. We have successfully disputed the merits and findings of reviews and audits brought by Centers for Medicare and Medicaid (CMS) contractors and private health insurers. Our firm employs a variety of approaches to remove providers from prepayment review, including:

  • Reviewing the denied medical claims and associated records to demonstrate that the provider or supplier complied with insurer policies and industry standards for coding, documentation, and medical necessity;

  • Challenging the statistical methodology used by insurers to extrapolate the alleged overpayment and/or disputing the validity of the auditor’s findings to reduce the provider’s overpayment liability;

  • Summarizing the findings of the medical records associated with each denied medical claim to explain the patient’s presenting problems, treatment history, the level of medical decision-making, and treatment provided to demonstrate that the medical claim was properly billed.

Regulatory Compliance

We help providers and other healthcare entities create comprehensive internal compliance policies to ensure compliance with relevant statutes, rules, and regulations. A sound compliance policy is necessary to safeguard healthcare providers against HIPAA and privacy breaches, allegations of fraud and abuse, and future claim denials, audits, and investigations. We assist our clients with compliance efforts by:

  • Conducting internal audits of provider billing, coding, and medical documentation (“GAP analyses”) to identify and fix areas causing claim denials;

  • Assessing providers’ internal compliance policies and practices to ensure that they comply with HIPAA, HITECH, and similar privacy laws;

  • Drafting internal reporting and self-disclosure policies;

  • Educating staff about relevant compliance and regulatory requirements; and

  • Creating customized corrective action plans to prevent future compliance violations.

Regulatory Approval and Clinical Trial Development

Medical device companies must overcome many regulatory challenges in order to successfully bring their innovations to market. At Bull Owen Law, we use our substantive knowledge of Clinical Trials and the U.S. Food and Drug Administration (FDA) regulatory process to help clients design and execute successful clinical trials, obtain FDA product approval, and to achieve their commercial and reimbursement objectives. We have successfully assisted clients with:

  • Drafting and negotiating clinical trial agreements for trials conducted in the U.S.;

  • Resolving regulatory issues arising from clinical trials for novel technologies, including wearable devices;

  • Providing counsel regarding Good Clinical Practices, human subject protection compliance procedures, and procedures regarding investigator-initiated research; and

  • Preparing and submitting premarket notifications (510(k)s) and premarket approvals to the FDA.

Trademarks

Bull Owen Law protects the intellectual property of healthcare providers, suppliers, and third-party billers by assisting with trademark filing, registration, maintenance, and enforcement. We select and file trademark applications with the United States Patent and Trademark Office, and appeal trademark registration denials with the Examining Trademark Attorney or with the Trademark Trial and Appeals Board (TTAB). We also manage your intellectual property portfolios to ensure that your trademarks are timely renewed and maintained, and author cease and desist letters to deter potential infringers.

Fraud and Abuse

As healthcare transactions are being increasingly scrutinized by the state and federal government, it has become imperative for healthcare providers to maintain effective internal policies to detect and resolve instances of fraud and abuse.

Allegations of fraud and abuse can result in severe consequences, including civil monetary penalties, medical license suspension or revocation, exclusion from participation in federally-funded programs, criminal charges, and even imprisonment.

Our firm educates providers about regulatory compliance requirements and helps develop comprehensive internal policies to safeguard providers against allegations of fraud and abuse.

In situations where the healthcare provider already faces fraud and abuse allegations, we vigorously defend our client before the state and HHS Office of Inspectors General, Medicaid Fraud Control Units, the FBI, and the Department of Justice. We represent clients in a variety of matters, including allegations brought under the False Claims Act, the Stark Law, the Anti-Kickback Statute, and the Eliminating Kickbacks in Recovery Act, and handle all areas of government investigations, including requests for documents, settlement negotiations, plea deals, corporate integrity agreements, and administrative appeals.

Telehealth

As the demand for Telehealth continues to expand, healthcare providers are presented with new opportunities to expand their business, providing care to more patients throughout more geographic areas. The benefits of Telehealth are numerous, including increased accessibility for patients, convenience for both the provider and the patients, reduced wait-times, and a decrease in overhead costs. At Bull Owen Law, we are dedicated to helping providers navigate the terrain of this new and expanding frontier. We assist clients with multiple matters concerning Telehealth, including:

  • Provider reimbursement;

  • Professional licensing and credentialing;

  • Provider enrollment and contract negotiations;

  • Regulatory compliance;

  • HIPAA and privacy laws; and

  • Fraud and Abuse defense and prevention.