Medicare Reimbursement Appeal: $6 Million Recovery

The Medicare Administrative Contractor (“MAC”) issued Medicare NPRs which substantially reduced our client’s Medicare reimbursement for its fiscal years that ended in 2000, 2001, 2002 and 2003. Our client, a large Maine Hospital, turned to Verrill Dana to appeal the MAC’s determinations. Working with the accounting firm Baker Newman Noyes, we prosecuted the appeals, developed significant supporting documentation, and presented our case to the Medicare Provider Reimbursement Review Board (“Board”) in Baltimore, Maryland on November 18, 2011. Following the first phase of the hearing, the MAC agreed to administratively resolve the appeals and will pay our client over $6 million. In addition, the MAC agreed to partial ARs for two of the fiscal years, which will allow the Board to issue a decision on an issue that remains in dispute. A favorable resolution of this issue may result in our client obtaining an additional $3 million dollars of Medicare reimbursement.