What to Look for in a Healthcare Reimbursement Attorney
Too many healthcare providers know the frustration of fighting with insurance companies over unpaid or underpaid claims. In these situations, an attorney may be able to help—but not just any attorney.
Understanding the complexities of the healthcare industry and navigating the process of claims reimbursement generally requires the experience of a healthcare reimbursement attorney. To learn more about what these attorneys do and how they can help your physician’s office or healthcare practice, read on.
What Does a Healthcare Reimbursement Attorney Do?
A healthcare reimbursement attorney (also sometimes called a medical revenue attorney, medical revenue recovery attorney, or simply health care lawyer) provides litigation services and legal advice to medical providers and organizations who need help with insurance reimbursement.
A healthcare reimbursement attorney’s list of clients might include hospitals, physician groups, solo practitioners, dentists, managed care organizations, home health providers, assisted living facilities and nursing homes, self-funded employers, and more.
Healthcare reimbursement attorneys typically engage in activities such as:
- Navigating and resolving third-party payer coverage issues and billing disputes, including Medicare and Medicaid reimbursement
- Providing advice and guidance on claims reimbursement methods and procedures
- Handling claims, audits, recoupments, disallowances, and administrative proceedings
- Negotiating (or renegotiating) payer contracts
- Investigating provider billing practices to demonstrate compliance with regulatory requirements and health law, including the Health Care Insurance Portability and Accountability Act (HIPAA)
- Navigating the complexities of healthcare legislation and regulation, like the No Surprises Act
- Defending or negotiating settlements for legal challenges such as False Claims Act or qui tam litigation as well as fraud and abuse claims
My legal representation at the Bryant Legal Group was outstanding. As a doctor, I appreciated their level of professionalism. Their experience and reputation in the field of disability claims played a major factor in the successful outcome of my case . . . Highly recommend!
- RELATED ARTICLE: 5 Ways Your Healthcare Organization Can Reduce Payer Denials
3 Key Factors to Consider When Choosing a Healthcare Reimbursement Attorney
When searching for the right healthcare reimbursement attorney, stay diligent and ask lots of questions.
Ideally, you want to develop a long-term relationship with a healthcare reimbursement attorney who will get to know your business and your needs. Think of each consultation with an attorney as the potential beginning of a partnership that may be vital for your business’ revenue and reputation.
Here are some of the most important factors to consider when evaluating a potential attorney for your physician practice or healthcare business.
Experience and Track Record
Of all the factors that distinguish a healthcare reimbursement attorney, experience is the factor that matters most. Healthcare reimbursement is a niche area of law that not many attorneys understand, and you don’t want your claim to serve as someone’s first experiment in this area.
When you talk with a potential healthcare reimbursement attorney, don’t be afraid to ask detailed, challenging questions about their experience and track record. Ask about how many health care industry clients they’ve represented, client outcomes, testimonials, and detailed explanations of their knowledge of these complex claims.
Also, be sure to ask for examples of clients who are similar to your organization in terms of size and complexity. An attorney who only works with solo practitioners might not have the resources to meet the needs of a larger corporate practice. Likewise, an attorney who exclusively works with big providers may not deliver the personal touch and level of responsiveness that a small office or solo practitioner might expect.
Bryant Legal Group case verdict: Our medical practice team recovered $500,000 for a physician group when an insurer failed to properly reimburse them for their services.
Reputation, Peer Reviews, and Recommendations
Even more telling than what a healthcare reimbursement attorney says about themselves is what their clients and your peers say. Start by asking other physician groups and healthcare professionals if they’ve heard of or worked with the firm you’re considering—although don’t worry too much if you don’t get any affirmative responses. Many doctors and healthcare professionals tend to stick with successful healthcare reimbursement attorney relationships and may not know any firms besides the one they work with.
To expand outside of your professional network, research the prospective firm or attorney online and read reviews from clients. Explore the firm’s website, including their testimonials and case studies. And if you want further reassurance, consider asking the attorney for references such as other physicians or healthcare organizations that you can get in touch with directly.
When working with a healthcare reimbursement attorney, it’s important that you and your team feel not just represented but seen, heard, and taken care of. When meeting with a potential attorney or firm, ask about their communication practices, how they make themselves available to clients, and how quickly they respond to messages and requests. Ask whether the attorney you’re currently meeting with will be your primary point of contact; if not, request to meet the attorney you’ll be working with.
Throughout your conversations and research, ask about any potential firm or attorney: Is this someone I can trust and feel comfortable with—not just for handling one particular claim but to act as my legal representative and to advocate for me continually through complex and challenging legal processes?
It’s hard to express in words the gratitude I have for Bryant Legal Group . . . David and Jennifer became family to me. They were knowledgeable and confident—as well as extremely personable and non-judgmental. Of course, we settled my case with a favorable result. Trust me. If you have a problem with your disability carrier, you want them representing you.
- RELATED ARTICLE: Do You Understand Your Healthcare Payer Contracts?
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Bryant Legal Group: Respected Medical Practice Attorneys in Chicago
Bryant Legal Group has built a reputation over decades as one of Illinois’ premier law firms for medical practices and payer-provider disputes. We have helped healthcare providers across the state renegotiate their contracts, navigate their complex provider-payer claims, and manage their revenue cycles.
We apply a client-centered approach that’s practical, sophisticated, and aggressive. If your organization has questions about boosting revenue and profitability, contact our office to schedule your free consultation with one of our healthcare lawyers today.
To get in touch with us, please call 312-667-2536 or complete our quick and easy online contact form.