Government & Insurance
In the fast evolving healthcare market, governmental oversight and payor investigations are becoming more common and potentially harmful to the financial health of your practice. Medicare RAC Audits, Third Party Payer Audits and inquires by the Office of Medicaid Inspector General and the Office of the Inspector General are all potential threats. Kirschenbaum & Kirschenbaum's healthcare team is committed to defending healthcare practitioners and practices in all areas of healthcare audit defense.
We also regularly represent our clients in prepayment reviews. We find by addressing compliance matters with an eye towards preventative planning, as well as mitigation, we are able to extricate our clients and defend against billing allegations while limiting exposure. We often work with coding and billing experts to ensure proper documentation and medically necessity for our clients and their services rendered.
There are three elements to Audit Defense and Avoidance:
We are committed to educating our clients and the healthcare community regarding audit exposure and best compliance practices. With all of the new laws, rules and regulations implemented, the first step towards compliance is knowledge,so, we have developed and published, free of charge, our healthcare email newsletter, where we answer questions from the healthcare community on a regular basis.
Compliance Plans are recommended for all practices, and required for NYS Medicaid providers who order or receive more than $500,000 or straight Medicaid or Medicaid-HMO reimbursement. We have worked diligently to offer transparent procedure and policy support at reasonable prices, including practice Compliance Plans. To ensure your practice is billing properly, a Compliance Plan is recommended not only by our firm, but by the Office of the Inspector General, CMS, and NYS Office of the Medicaid Inspector General which agency is checking for compliance and requires certification thereof for required providers.
3. Policies, Procedures and Documentation
The best defense is to adopt proper policies and procedures, designed to avoid risk and to build a cogent record to respond to any inquiry. Meticulous documentation and adherence to well thought out and constructed polices create a solid , factual basis to respond to and defend your practice in an audit.
Every practice requires assistance collecting from patients or payors. Here at K&K we offer a myriad of services to assist in your collection process. We offer the drafting of a legal letter directing payment to your practice for a flat fee of $30, and if unsuccessful or not the route you are looking to take, we will take immediate legal action and begin the legal collection process. We are happy to assist in any patient or payor dispute.
Because we are committed to educating and protecting our clients and the healthcare community about the ever-changing compliance requirements, we've amassed a tremendous library of easily accessible information and deliver tools to protect your practice from compliance risk . Knowing what is required of you and your practice is the first step. The second element is preparation and preventative action for you and your practice. We work with our clients on a day-to-day approach, mitigating potential exposure with staff and managers through proper policy and procedure development. The third element is mitigating exposure and potential damages by offering competent, comprehensive and cost-effective representation should an audit, investigation or review by a governmental agency or payer arise. Our firm is committed to assisting our clients with all compliance needs, including but not limited to:
- Self-Referral Compliance (Stark Law)
- Anti-Kickback Compliance
- HIPAA Compliance
- HITECH Act Compliance
- Security Policy Compliance
- E-Prescribing Compliance
- OSHA Compliance
- Workers Compensation Compliance
- Employment Practices Compliance
- Li censure Compliance
- Compliance with all relationships and arrangements
Our approach to litigation is simple - obtain our client's objectives as expeditiously and efficiently as possible. Our experienced team of healthcare litigators are available to represent you in litigation related to yours or your practice's needs, including but not limited to:
- Partnership Disputes
- Trademark Disputes
- Insurance Disputes
- Privileges Disputes
- National Practitioner Databank Disputes
- Trade Secret Disputes
- Contract Disputes
We understand that litigation is not a forum you may be familiar with, and it can be costly. We work with our clients from the start of our representation in a transparent manner, detailing process and potential expense given the circumstance and strategy.
PRACTICE CONTRACTS & TRANSCRIPTIONAL MATTERS
(Employment, Buy/Sell, Partnership, ACOs, IPAs, Article 28 Facilities)
The foundation of a healthy and proper practice begins with solid and comprehensive contracts. We assist our clients with their transactional needs working collaboratively to identify their structure needs and to understand all relevant deal terms. Once the outline of the proposed arrangement has been established, we provide a detailed quote of the work required. Thereafter we will draft any and all arrangement documents, negotiate, finalize and effectuate execution. Our healthcare team specializes in representing clients in all types of healthcare transactional matters, including but not limited to:
- Employment Contract Review and Negotiation
- Employment Contract Drafting for Employers
- Practice Formation Drafting (Certificate of Incorporation, Articles of Incorporation, Corporate Kit Document Drafting)
- Practice Management Drafting (Employee Handbook, Practice Policies and Procedures and other required Practice documents)
- Practice Purchase or Sale (Asset Purchase Agreement, Stock Purchase Agreement)
- Partnership, Shareholder and Operating Arrangements
- Independent Practice Associations and Accountable Care Organizations
- Large Group Practice Membership and Formation
- Article 28 Membership and Formation Contract Review and Drafting for Members and Organizers
Our healthcare transactional team serves as counsel to medical practices fulfilling all transactional needs regarding employment, partnership agreements, shareholder agreements, operating agreements, as well as asset purchase agreements and stock purchase agreements for buy/sells.
Our approach to our clients' licenses is simple - assisting you in maintaining or obtaining a clean license is our top proirity. Unlike other firm's who may parade clients in front of a goverment agency, we effectuate representing our clients in maintaining or obtaining a clean license by minimizing your exposure to the overseeing government agency, to the degree possible, and working with you and the applicable government agency to mitigate your potential exposure. Experience dictates that swift action and limited exposure effectuates expeditious resolution, which is our aim in each licensure representation by our team.
Kirschenbaum & Kirschenbaum's healthcare team is committed to representing healthcare practitioners in licensure matters, including but not limited to:
- Office of Professional Medical Conduct inquiries, audits and investigations
- Office of Professional Discipline inquiries, audits and investigations
- Education/Training Disputes
- Residency Disputes
- Assistance with Licensure Process
We are committed to preventing our clients from having to experience an OPMC or OPD investigation. Should you receive an inquiry letter or visit, the first step is being prepared. The below are intended to assist educate.
Should an OPMC or OPD investigator visit your practice, please do not engage with that individual and contact our office immediately.
Looking to take preventative measures -
K&K's Prepaid Legal Audit and investigation defense Now
As a value-add to our clients and the healthcare community our firm has developed K&K's PLAN - Prepaid Legal Audit and investigation defense Now. PLAN participation is not required for clients of the firm, however, participants are assured representation at reduced legal fees, with certain services included in membership. For additional information about K&K's PLAN, CLICK HERE or the image below.
To discuss a licensure matter or potential licensure issue, contact Jennifer Kirschenbaum, Esq. at (516) 747-6700 x. 302 or at Jennifer@Kirschenbaumesq.com for a free consultation.
Our approach to our clients' licenses is simple - assisting you in maintaining or obtaining a clean license is our top priority. We effectuate representing our clients in maintaining or obtaining a clean license by minimizing your exposure to the overseeing government agency, to the degree possible, and working with you and the applicable government agency to mitigate your potential exposure. Experience dictates that swift action and limited exposure effectuates expeditious resolution, which is our aim in each licensure representation by our team.
Our healthcare team understands the issues facing practices today - including decreasing reimbursement. We are here to assist by providing compliance and management support by aiding in the development and implementation of your practice's policies and procedures, as well as assisting in strategy and operational implementation. To discuss practice management concerns, including but not limited to issues with employees, management, patient issues, governmental or payor investigations, audits or reviews, issues with contracting with insurance companies or other practice issue, contact Jennifer Kirschenbaum, Esq. for a free consultation at (516) 747-6700 x. 302 or at Jennifer@Kirschenbaumesq.com.
K&K's VALUE-ADD SERVICES
Policies and Procedures
As a value-add to our clients and our healthcare community we have worked diligently to offer transparent procedure and policy support at reasonable prices. We have developed a comprehensive Employee Handbook, regulatory compliant HIPAA Policies for staff training and patient distribution, patient financial policies requiring patients pay for services rendered, as well as other policies and procedures required by government agencies and third party payors interacting with practices on a daily basis. To view our compliance documents available for purchase through our website, CLICK HERE.