David M. Traskey
Partner
202-844-3256
Wound Care and Skin Substitutes
- Overview
- Attorneys
- Insights
For providers working in the wound care space, and particularly those that apply skin substitutes[1], to repair complex, hard-to-heal wounds, it is not a question of “If your practice will be audited or investigated.” It is a question of “When will your practice be audited?” Having the right team in place is critical. Your professional reputation and your ability to get reimbursed for the medically reasonable, necessary, and appropriate care you provide to patients depend on it.
Our multi-disciplinary team comprised of former government attorneys, medical necessity experts, and billing, coding, and documentation specialists understands the nuance and complexity of the wound care practice area, as well as the government’s case identification strategies, its legal theories and interpretation of applicable laws, rules, and regulations. Our team has extensive experience representing practices and providers through all five stages of the Medicare appeals process.
The Wound Care and Skin Substitute Practice Group advises our clients in the following representative areas:
- Responding to records requests from the Unified Program Integrity Contractors (UPICs)
- Analyzing patient medical records, claims data, and billing and coding records
- Preparing appeals of unfavorable Redetermination and Reconsideration decisions, Administrative Law Judge Decisions, and decisions by the Medicare Appeals Council
- Representing practices and providers at Administrative Law Judge hearings, before the Medicare Appeals Council, and in connection with appeals to the United States District Court
- Negotiating extended repayment schedules with the Centers for Medicare & Medicaid Services (CMS)
- Advising on payment disputes with skin substitute manufacturers, distributors, and sub-distributors
- Responding to subpoenas, administrative actions, civil investigative demands, and/or criminal matters initiated by the U.S. Department of Justice or the U.S. Department of Health and Human Services, Office of Inspector General
* * * * * * * * *
[1] Also known as cellular, acellular, and matrix-like products (CAMPs).
Practice Group Contacts
Team
An Appellate Win for Skin Substitute Providers
David Traskey recently secured a fully favorable decision in a client’s skin substitute case at hearing before an Administrative Law Judge.
Forming the Right Skin Substitute Team
As a successful podiatrist treating complex wounds with skin substitutes, your growing reputation also brings increased risk of audits, investigations, and costly claw backs from Medicare, Medicaid, and insurers. With billions spent annually on these treatments, government scrutiny is intensifying. Protect your practice by building the right team—experienced health care attorneys, top medical experts, and skilled billing and documentation specialists—before issues arise. Garfunkel Wild focuses exclusively on health care law and offers the resources to safeguard your practice, reputation, and livelihood.
Avoiding Self-Inflicted Wounds: Responding to Government Audits Involving Skin Substitutes
Given the massive increase in Part B expenditures related to skin substitute products, government regulators are auditing Medicare Part B claims and investigating providers right now to identify and claw back millions of dollars of payments at risk for non-compliance with Medicare requirements. Partner with experienced legal counsel in advance of being audited or investigated, after you’ve received a government inquiry, or for help with your Medicare appeal. Don’t go it alone. Have a plan and understand your options.
For providers working in the wound care space, and particularly those that apply skin substitutes[1], to repair complex, hard-to-heal wounds, it is not a question of “If your practice will be audited or investigated.” It is a question of “When will your practice be audited?” Having the right team in place is critical. Your professional reputation and your ability to get reimbursed for the medically reasonable, necessary, and appropriate care you provide to patients depend on it.
Our multi-disciplinary team comprised of former government attorneys, medical necessity experts, and billing, coding, and documentation specialists understands the nuance and complexity of the wound care practice area, as well as the government’s case identification strategies, its legal theories and interpretation of applicable laws, rules, and regulations. Our team has extensive experience representing practices and providers through all five stages of the Medicare appeals process.
The Wound Care and Skin Substitute Practice Group advises our clients in the following representative areas:
- Responding to records requests from the Unified Program Integrity Contractors (UPICs)
- Analyzing patient medical records, claims data, and billing and coding records
- Preparing appeals of unfavorable Redetermination and Reconsideration decisions, Administrative Law Judge Decisions, and decisions by the Medicare Appeals Council
- Representing practices and providers at Administrative Law Judge hearings, before the Medicare Appeals Council, and in connection with appeals to the United States District Court
- Negotiating extended repayment schedules with the Centers for Medicare & Medicaid Services (CMS)
- Advising on payment disputes with skin substitute manufacturers, distributors, and sub-distributors
- Responding to subpoenas, administrative actions, civil investigative demands, and/or criminal matters initiated by the U.S. Department of Justice or the U.S. Department of Health and Human Services, Office of Inspector General
* * * * * * * * *
[1] Also known as cellular, acellular, and matrix-like products (CAMPs).
Practice Group Contacts
Team
An Appellate Win for Skin Substitute Providers
David Traskey recently secured a fully favorable decision in a client’s skin substitute case at hearing before an Administrative Law Judge.
Forming the Right Skin Substitute Team
As a successful podiatrist treating complex wounds with skin substitutes, your growing reputation also brings increased risk of audits, investigations, and costly claw backs from Medicare, Medicaid, and insurers. With billions spent annually on these treatments, government scrutiny is intensifying. Protect your practice by building the right team—experienced health care attorneys, top medical experts, and skilled billing and documentation specialists—before issues arise. Garfunkel Wild focuses exclusively on health care law and offers the resources to safeguard your practice, reputation, and livelihood.
Avoiding Self-Inflicted Wounds: Responding to Government Audits Involving Skin Substitutes
Given the massive increase in Part B expenditures related to skin substitute products, government regulators are auditing Medicare Part B claims and investigating providers right now to identify and claw back millions of dollars of payments at risk for non-compliance with Medicare requirements. Partner with experienced legal counsel in advance of being audited or investigated, after you’ve received a government inquiry, or for help with your Medicare appeal. Don’t go it alone. Have a plan and understand your options.