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The health care law practice of The Martin Law Firm, P.C. provides transactional and litigation services for all types of licensed health care providers. We provide legal solutions for Physicians, Chiropractors, Nurse Practitioners, Physician Assistants, Physical Therapists, Massage Therapists, Speech Language Pathologists, Dentists, and DMEPOS suppliers. The Martin Law Firm, P.C. also represents state associations whose members are licensed providers, practice management companies, electronic health record software vendors, and medical billing companies.
Our health care attorneys help providers navigate through the complex statutes, regulations, and policies that govern the various health care professions.
Litigations, Audits and Overpayment Determinations
To reduce fraud, waste and abuse within the health care system, Medicare, Medicaid and commercial insurance payers routinely perform retroactive audits of claims submitted by healthcare providers to determine whether the providers submitted “clean” claims for reimbursement.
These audits begin with a request for medical records which are then sent to a consultant for review. The consultant will identify non-compliance with billing, coding and documentation rules and policies in order to justify an overpayment determination. The payer will then demand a return of the overpayments directly from the provider or, in some instances, will offset the overpayment amount against current and future claims submitted by the provider.
The Martin Law Firm, P.C. represents health care providers by appealing and challenging the payer’s retroactive claim denials. We utilize our knowledge of the law, our experience and understanding of payer policies and guidelines, and our network of coding and compliance experts to create an effective rebuttal to retroactive claim denials. Over the years we have saved health care providers millions of dollars in retroactive claim determinations. Click the following links for more information on retroactive audits and appeals:
The Martin Law Firm, P.C. creates and implements Compliance Programs for health care providers. A Compliance Program is a written source of information for health care providers that incorporates laws, policies and guidelines that relate to reimbursement matters such as billing, coding and documentation as well as state and federal health care laws that impact the daily practice of licensed practitioners.
In 2000, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) established compliance program guidance.
The Martin Law Firm, P.C. has developed and maintained the standards that all providers and small group practices should implement to avoid retroactive audits and mitigate the impact of an audit. Cookie cutter or “off-the-shelf” Compliance Programs are ill-advised. Our Compliance Programs are specially tailored for each licensed professional (M.D., D.C. P.T., etc.) and are designed to be the main source of information for providers who want to increase and protect their reimbursement.
Professional Licensure and Disciplinary Proceedings
Healthcare Practice Acquisitions
Pennsylvannia Act 6 Appeals
Multi Disciplinary Practices
Physicians, chiropractors, podiatrists, physical therapists and other healthcare providers face a constantly evolving and highly regulated industry. Additional regulations and changes within the healthcare industry often compel the provider to expand his or her practice.
For individual and small groups, licensed providers often see the value in a multidisciplinary practice. A multidisciplinary practice is an entity that combines two or more types of providers that offer multiple healthcare services, e.g., MD/DC practice. A multidisciplinary practice offers patients comprehensive medical care. Patients with various health problems may be able to receive chiropractic care and medical care at the same location, which facilitates a holistic approach to care and convenience. Setting up a multidisciplinary practice requires health care law expertise due to the numerous statutes and regulations governing the healthcare industry. The Martin Law Firm, P.C. has the experience necessary to set up a proper multi-disciplinary practice that complies with Federal and State laws and regulations.
Federal and State Laws
Our legal team provides individualized legal solutions for our clients by offering high quality legal counsel and representation in diverse areas of law. Our attorneys regularly represent clients throughout Southeast Pennsylvania, including Montgomery County, Bucks County, Chester County, Delaware County, and Philadelphia County.
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