Fotheringill & Wade, LLC’s practice is focused exclusively on advising and representing hospitals and health systems at each stage of the denial and appeals management process. We appeal denied and underpaid claims, advise clients on achieving favorable contract terms with payers, educate clients regarding their rights and responsibilities under Federal and State laws and regulations, and provide consulting services geared toward implementing denial prevention strategies. Our goal is to ensure that hospitals are adequately reimbursed for the services they provide.
News & Events
Citing a decrease in appealed claim decisions and an increase in the acceptance of provider education under the pilot program, CMS has announced that they have decided to expand the Targeted Probe and Educate (TPE) program to all MAC jurisdictions in latter part of 2017. The TPE program grew out of the broad Probe and Educate program initiated by CMS in 2014. The TPE program began as a pilot in one MAC jurisdiction in June 2016 and was expanded to three additional MAC jurisdictions in July 2017. Read More
On Friday, the U.S. Appeals Court for the District of Columbia overturned an order requiring Department of Health and Human Services (HHS) to clear its backlog of Medicare reimbursement appeals by the end of 2020. Indicating that the district court “declined to seriously grapple with the Secretary’s assertion that lawful compliance with such a mandamus order would be impossible,” the appellate court ruled that it was an “error or law” and an “abuse of discretion” for the district court to order the Secretary to perform an act – clear the backlog by certain deadlines – without evaluating whether performance was possible. Read More