Reimbursement Audits, Appeals & Compliance
Healthcare providers face intensive scrutiny from government agencies and private insurers, making proper reimbursement compliance a critical component of practice management. At Goodman Allen Donnelly, we provide strategic counsel and aggressive representation for providers and organizations dealing with audits, appeals, and reimbursement disputes. Our attorneys understand the unique challenges faced by primary care and specialty practices, long-term care facilities, ambulatory surgery centers, and independent diagnostic treatment facilities, and we work to protect our clients’ interests while ensuring compliance with complex regulations.
Audit Defense & Reimbursement Appeals
Our team represents healthcare professionals and organizations in responses and appeals related to:
- Medicare, Medicaid, and TRICARE audits – Including Recovery Audit Contractor (RAC) reviews and Program Integrity audits
- Virginia Department of Medical Assistance Services (DMAS) – Handling informal and formal appeals of reimbursement audits
- Commercial insurer audits and reimbursement disputes – Addressing challenges over coding, documentation, and medical necessity
We work closely with clients to respond to audits, challenge findings, and appeal denied claims, helping minimize or eliminate liability and overpayment demands.
Coding, Documentation & Compliance Standards
Proper billing and documentation are crucial in preventing audits and disputes. We assist clients in developing and maintaining compliance with coding and documentation standards, including:
- Primary care and specialty physician practices – Ensuring documentation aligns with CPT, HCPCS, and ICD-10 requirements
- Independent diagnostic and treatment facilities (IDTFs) – Addressing regulatory documentation and coding requirements
- Ambulatory surgery centers (ASCs) – Ensuring reimbursement practices meet CMS and payor-specific guidelines
- Other healthcare providers and suppliers – Evaluating compliance programs to minimize audit risk
Our attorneys work with clients to provide staff training, internal audits, and corrective action plans (CAPs) to reduce exposure and improve billing accuracy.
Cost Reporting Compliance for Long-Term Care Facilities
Long-term care facilities face unique cost reporting and reimbursement challenges, including:
- Adherence to Medicare and Medicaid cost reporting standards
- Preparation and submission of cost reports
- Responses to reimbursement inquiries and disputes related to cost reporting
We help long-term care facilities identify and resolve errors, ensuring compliance with both federal and state requirements while protecting their financial stability.
Why Choose Us?
With extensive experience in reimbursement compliance, appeals, and audit defense, Goodman Allen Donnelly is committed to helping healthcare providers minimize risk and resolve reimbursement disputes efficiently and effectively. Whether you are dealing with a Medicare, Medicaid, TRICARE, or commercial payor audit, or need assistance with cost reporting and compliance for long-term care facilities, we provide tailored legal strategies to protect your business and reputation.
Contact us today to discuss your audit response, reimbursement dispute, or compliance needs.
