Healthcare Reimbursement

Few industries experience the change that the healthcare industry experiences on a constant basis. Healthcare providers operate in a highly regulated and scrutinized business environment. Now, more than ever, healthcare providers need timely, creative, practical, and cost-effective solutions to the legal issues they face.

A necessary part of any business is collecting the revenue you have earned. In healthcare, because of the complex rules affecting reimbursement and the many different payers (both private and governmental), getting paid the money you deserve can be especially challenging. Glazer Law PLLC can help. Getting results often requires innovation and imagination. Through the years, Joe's work has resulted in his clients receiving hundreds of millions of dollars in additional reimbursement.

Among other matters, Joe has represented hospitals before the PRRB and in Medicaid rate matters before State agencies, helped providers resolve payment disputes with insurers, and worked with hospitals on complex Medicare wage index matters to ensure the providers are receiving the full reimbursement to which they are entitled. A few of the matters in which Joe has helped clients are highlighted below.

Section 401 Hospitals (Urban-to-Rural Redesignation)

Joe has had particular involvement and success in recent years changing HHS and CMS policy regarding the treatment of geographically urban hospitals that have redesignated from urban to rural status (often referred to as Section 401 hospitals). Joe’s court victories and legal work have been repeatedly cited by CMS as the basis for CMS changing its regulations related to Section 401 hospitals to be consistent with the positions Joe has argued on behalf of his clients. Joe success in this area includes the following court decisions: Geisinger Community Med. Ctr. V. Sec’y U.S. Dept of Health & Human Servs., 794 F.3d 383 (3d Cir. 2015); Lawrence + Memorial Hosp. v. Burwell, 812 F.3d 257 (2d Cir. 2016); Bates Cnty. Mem. Hosp. v. Azar, 464 F. Supp. 3d 43 (D.D.C. 2020). In the Federal Fiscal Year 2024 Final Rule, CMS again cited Joe’s court victories and legal representations when CMS prospectively changed the methodology by which CMS includes Section 401 hospitals when calculating the rural wage index and the rural floor.

Medicare Reimbursement Appeals

Joe frequently represents hospitals in Medicare reimbursement appeals before the Provider Reimbursement Review Board. He is the attorney responsible for the favorable PRRB decision in Jersey Shore Medical Center v. Blue Cross and Blue Shield of New Jersey. That seminal decision laid the groundwork for New Jersey hospitals to receive hundreds of millions of dollars in additional Medicare DSH payments. Joe worked closely with New Jersey’s Federal delegation to ensure hospitals received the benefits of the decision.

Imputed Floor Rule for Hospitals

Joe was intimately involved in creating an imputed Medicare wage index rural floor for New Jersey hospitals. He constructed the arguments supporting a rural floor in New Jersey, drafted proposed legislation, and evaluated litigation options. He again worked closely with New Jersey’s Federal legislative delegation to support their efforts to obtain a fair resolution for New Jersey’s hospitals. Since its inception, the imputed rural floor has resulted in hospitals in all-urban states receiving over $1 billion in additional Medicare reimbursement.

Medicaid Reimbursement

Joe has represented numerous hospitals in Medicaid reimbursement matters, including with respect to appeals of their Medicaid inpatient rates. He was also retained as special healthcare counsel for a liquidation trust established to address the claims of creditors of Allegheny Hospitals, New Jersey.