Private practices, dentist offices, hospitals, any facility that offers medical services may be eligible to bill Medicare for these services. But what happens if there is an issue with the billing procedure? What if that issue snowballs to the point where Medicare rescinds their contract and no longer pays for claims from your facility?
Can you ever regain that contract?
A recent example provides some hope for those in this situation. The example comes from a hospital out of Texas. The hospital, United Memorial Medical Center in Houston, is fighting back after the United States Centers for Medicare and Medicaid Services (CMS) decided to terminate their contract in January of 2022.
The hospital appealed the agency’s decision and is pushing for recertification. Two important steps towards achieving this goal include:
- Accreditation. One point in the hospital’s favor is the fact that they passed an unannounced inspection. This resulted in an accreditation from the Center for Improvement and Healthcare Quality and shows that the facility is meeting CMS’ regulations. The inspection included a tour of the facility, review of medical records, observation of patient care practices and interviews with staff and patients.
- Recertification. Next, the facility will need to apply to the CMS for recertification.
The group is hopeful it will regain the contract, but the process can take time. Those who are in a similar situation can mitigate some of this time by seeking legal counsel experienced in this niche area of the law. The steps noted above are an important part of the process but putting together an aggressive response can better ensure an efficient resolution.
Attorney John Rivas is responsible for this communication