About Us

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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

On Friday, November 3, 2017 CMS announced that it will make available a new settlement option for eligible providers and suppliers with a low volume of Medicare Part A and B claim appeals pending at OMHA and/or the Medicare Appeals Council. CMS also announced that OMHA will be expanding the Settlement Conference Facilitation Process for certain appellants that are not eligible for the LVA option. Read the full post here.

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