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 Thursday, February 15th, the American Hospital Association (AHA) and three member hospitals urged the U.S. District Court for the District of Columbia to reinstate its earlier order requiring the Secretary of Health and Human Services to clear the Medicare appeals backlog at the administrative law judge (ALJ) level within five years. The District Court order was rescinded by the Appeals Court in August. In remanding the case, the appeals court left the lower court free to reinstate the same requirement if HHS fails to demonstrate that it is “impossible” to comply with the mandamus order. In yesterday’s brief the AHA urged the court to do just that. “Because the Secretary has not shown it is impossible to clear the backlog—minus, perhaps, some claims with serious program-integrity concerns—within five years, the Court should require him to do so.” Read More
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.