Healthcare Reimbursement

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. We can help. Joe works tirelessly to ensure his clients are properly compensated for their hard work. Getting results often requires innovation and imagination. Through the years, Joe has helped providers receive hundreds of millions of dollars in additional reimbursement.

Among other matters, Joe has represented dozens of 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.

Medicare Reimbursement Appeals

Joe has represented dozens of hospitals in Medicare reimbursement appeals before the PRRB. 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 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.

Medicaid Reimbursement

Joe has represented numerous hospitals in Medicaid reimbursement matters, including approximately 20 hospitals with respect to appeals of their Medicaid inpatient rates. He also was retained as special healthcare counsel for a liquidation trust established to address the claims of creditors of Allegheny Hospitals, New Jersey.