No matter how important payment is, its
a serious step to initiate legal proceedings in order to collect
payment. In many cases, though, its a critical and valuable
component of encouraging payers to fulfill their obligations. Kent
gives our clients this option, without the need to outsource to
another agency. Indeed, our clients find that just the knowledge
that they have this option at their immediate disposal is enough
to overcome barriers to payment by many payers and government agencies.
PV Kent & Associates attorneys are available
full-time to support healthcare providers legal needs. Our
attorneys provide a range of services. For example, they:
Cease improper attempts by payers to recover alleged overpayments
Secure claims against solvent estates for recovery of unpaid
Demand and obtain payment from individual ERISA plans, private
commercial carriers, and government payers
Assist and defend providers during audits conducted by state
Review and assist providers with insurance contract negotiations
legal matters pertaining to contractual agreements
Pursue self-pay claims
Submit appeals to courts and various administrative agencies
Unlike most companies, Kent has in-house
attorneys who can litigate when deemed necessary. This ensures seamless
coordination that is not possible when working with multiple firms.
In the event that administrative appeals
for proper payment are exhausted, Kent attorneys can prosecute appeals
before a variety of entities, including the Office of Medicaids
Board of Hearings and the District and Superior Courts of both Massachusetts
and New Hampshire. They have been successful in contesting non-payment
Pre-payment denials and post-payment recoupment efforts
Third-party liability and COB issues
Attempts by payers to recover based on insurance identified after
has already been made
Improperly denied claims by Medicaid and other state agencies
Administrative denials by responding to MassPRO in
strict program guidelines
Third-party administrator and re-insurer denials
There are occasions when healthcare providers
seek remedy for unpaid medical bills from the solvent estate of
a patient who has died. Kents attorneys coordinate closely
with clients throughout the entire process of pursuing payment.
They file necessary documents with the courts and initiate litigation
against the administrator or executor of the estate within the tight
deadlines established by state regulation. They have extensive experience
searching probate court dockets, communicating with estate attorneys,
negotiating settlements, and filing the requisite legal paperwork. Kents
lawyers are firm and yet ever mindful of the need to protect and
enhance our clients standing in the communities they serve.
ERISA (Employee Retirement Income Security
Act of 1974) specifies the federal standards for healthcare benefits
payable under self-funded group health insurance plans. ERISA can
be a minefield, but our experience in this area allows us to recover
a significant number of improperly denied claims.
Kent attorneys operate skillfully within
the complexity of ERISA regulations. For example, they work closely with third-party administrators, trustees, and re-insurers
of an ERISA plan to resolve issues without the need to resort to
unnecessary litigation. They can identify whether or not ERISA preempts
state insurance laws early enough in the process to avoid
delays and unnecessary courses of action. They manage denials thoroughly
to ensure that their clients can effectively contest a claim, through
all phases of the process, including litigation, if necessary.
As usual, Kent attorneys advocate, negotiate,
and then litigate, when necessary and appropriate. They carry out all the
activities required to maximize revenue for the healthcare provider.
This includes making payment demands, notifying the Department of
Labor of ERISA plan violations, seeking noncompliance penalties,
and recovering litigation costs.
Healthcare providers regularly undergo audits
by insurers and government agencies, during which they must disclose
their reimbursement related accounting records. As a law firm, Kent can assist
in the audit itself. In cases where auditors cite questionable violations
and overpayments, Kent can challenge their findings. In many audit cases
we have significantly reduced or even eliminated repayments,
fines, and sanctions purportedly due to based on the auditing entity's review. Healthcare providers need to be aggressive in defending such auditing and related take back efforts because the complexity and constant change in the healthcare reimbursement area often results in erroneous audit results.
Attorney Representation / Self-pay Accounts
Kent attorneys address the full spectrum
of legal matters that pertain to healthcare providers. Because Kent
is focused on the business of supporting healthcare providers, we can deliver
a more competent level of support for these matters than most other
law firms and similar vendors.