Medicare Part B providers who apply skin substitute products, also known as cellular, acellular, and matrix-like products (CAMPs), have been on the hot seat for over a year because of various audits and investigations by government regulators. These audits and investigations typically focus on whether the care rendered was medically reasonable and necessary as well as whether the products applied were investigational or experimental. Many providers are navigating the complex Medicare appeals process unprepared or underprepared, losing appeals, and having to repay millions to Medicare. Even with representation, the deck appears stacked against the providers as evidenced by the avalanche of unfavorable decisions issued across all levels of the appeals process.
Against this backdrop, David Traskey, a partner and the co-head of Garfunkel Wild’s Washington, D.C. office, recently secured a fully favorable decision in a client’s case at hearing before an Administrative Law Judge. “Having the right team in place at the right time was instrumental to our client’s success,” David said. He also credited Garfunkel Health Advisors, Inc. and Daniel Kapp, M.D. and his expert team at MEDNAC, LLC with the positive outcome. “Clients can increase their likelihood of success by using a qualified legal team and the right mix of billing, coding, and documentation specialists, as well as highly qualified medical necessity experts,” David added.
Should you have any questions regarding the above or need help responding to a government audit or investigation, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].
