An interview with Stephen Bittinger of Bittinger Law.
What makes Bittinger | Law unique among healthcare law firms?
We have developed a specialized practice that focuses almost entirely on healthcare reimbursement defense and compliance. This area of law leads into several main areas of work. The first and most frequent is the defense of audits by federal, state, and private payors. Needless to say, protracted audits can chock the life out of a practice, and we have developed very successful strategies for bringing them to swift resolutions and mitigating damages significantly. The second major arena that we work is reimbursement compliance, and we wish more clients would come to us before there were problems. Legal payor compliance is not only coding and medical policy adherence but contract, regulation, and structural compliance as well. The third major area is the myriad of pitfall processing that result from failures of reimbursement compliance such as OIG or FBI investigations, de-credentialing proceedings, payor litigation, False Claims Act litigation, and other difficult processes.
Our firm is unique, in that our knowledge framework always begins and ends with reimbursement and the legal framework around those processes. Many large healthcare law firms list these areas of law among the many others that they handle (e.g. healthcare transactions, physician contracting, etc.), but we live and breath the law as it applies how providers get paid for services and protect their revenue. Since we are so focused, we are on the forefront of the ever-evolving world of law and policy that surrounds healthcare reimbursement.
How do you define the legal side of healthcare reimbursement defense and compliance?
The easiest way to define the legal side of healthcare reimbursement is to describe the layers. To begin with, you have the coding of services. The rules and authorities that create, change, and implement the codes all have varying basis of legal grounds for their positions. The second is the legal construct of the payor. For private payors, the primary basis is the provider’s participating contract and the incorporate payor manual and medical policies. Note, that most all private payors default to CMS standards where their policies are silent. For federal and state payors, you have the dark abyss of “contracts” for participation, manual and medical policies, federal and/or state regulations, and federal and/or state statutes. Needless to say, the complexity, and frequent conflict, between all these layers of duties, rights, and responsibilities often overwhelm private medical practices.
What types of legal matters do you help providers and practices with?
As briefly mentioned above, our predominate work is in audit defense and compliance, but the heart of our reimbursement knowledge has taken us into some very interesting arenas. We represent individual providers in state board defense when a payor has accused them of unethical billing. We defend against healthcare fraud investigations by the FBI, OIG, HHS, and AG. We have both defended against and prosecuted False Claims Act cases. We have defended providers in de-credentialing and termination proceedings. We also very often appeal erroneous findings of overpayment with success. Generally, if it boils back down to something going wrong with the reimbursement, we’ve seen it.
When is the best time for a provider/practice to reach out to a healthcare attorney and why?
Always beforehand. Please let me say that again. Providers should always at least know of a firm like ours before the trouble comes. I have many times stopped the terrible effects of a federal fraud audit by receiving a call on the day the audits show up unannounced at the practice. This is only possible if you know my number before that day.
Why is education such an important part of the healthcare reimbursement process?
Education kills fear. Fear often causes providers to ignore their responsibilities or fail to receive everything they should for their services. Healthcare is extremely complicated, and I would never want to be going it alone.