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
In an effort to compel Anthem’s Blue Cross Blue Shield of Georgia to rescind its “controversial and dangerous emergency care policy” that retroactively denies coverage for emergency patients, the American College of Emergency Physicians (ACEP) and Medical Association of Georgia (MAG) have filed suit in the U.S. District Court for the Northern District of Georgia. The policy, implemented by Anthem in Georgia and five other states over the past year, leaves patients who sought emergency care responsible for paying their entire bills if Anthem determines, after retrospective review, that their diagnoses were not truly emergencies. Along with Georgia, the other states include Indiana, Kentucky, Missouri, New Hampshire and Ohio. Read More
CMS has announced that the Office of Medicare Hearings and Appeals (OMHA) will be expanding its current Settlement Conference Facilitation (SCF) program to reach additional providers and suppliers. Medicare Part A and Medicare Part B providers and suppliers who have OMHA or Medicare Appeals Council (Council) appeals pending may be eligible to participate in the expanded SCF process. Read More