Government Reimbursement » Print This Page

Government reimbursement forms the core of Gjerset & Lorenz, LLP’s healthcare law practice. Our attorneys are nationally recognized for their work on complex issues in governmental reimbursement programs, such as Medicaid, Medicare, CHAMPUS, and workers’ compensation reimbursement programs. 

Reimbursement from state and federal government sources for healthcare services significantly impacts the financial health and daily operations of hospitals and other healthcare providers.  Gjerset & Lorenz attorneys know how vital and difficult complying with government reimbursement requirements can be. We realize reimbursement structures are often counterintuitive and require in-depth understanding of nuances, and we help clients navigate complicated reimbursement procedures.

We offer a full range of reimbursement-related services, helping our clients obtain the full amount of reimbursement to which they are entitled while also building compliant, auditable records. 

Medicaid Reimbursement

For the past several years, we have focused on optimizing Medicaid participation and reimbursement for our clients. We do so by identifying opportunities for providers to receive additional reimbursement for services they already provide to Medicaid beneficiaries. In some cases, this means engaging in more sophisticated participation in existing Medicaid reimbursement programs. In other cases, it means identifying, developing, and implementing new Medicaid supplemental reimbursement programs or identifying additional financing for existing Medicaid programs. 

Representative Examples

Gjerset & Lorenz has provided representation and advice on government reimbursement issues that include: 

  • Developing coalitions between non-profit, investor-owned, and public hospitals to better utilize community resources to finance healthcare service needs of the indigent community in collaboration with community leaders and state and local government agencies.
  • Working with hospitals in over ten states to develop and implement reporting systems, ensure accuracy in reporting, and prepare administrative appeals related to their participation in the Medicaid Disproportionate Share Hospital program.
  • Analyzing the financial implications of Medicaid reform initiatives, including Medicaid Managed Care expansions, Medicaid Waiver Programs, and provider fees.
  • Designing aggregate cap demonstration models to assist state Medicaid Agencies with Medicaid State Plan Amendments and responding to audits from the Centers for Medicare and Medicaid Services.
  • Assessing opportunities to enhance Medicaid payments to hospitals and physicians in collaboration with Medicaid Managed Care Plans.
  • Preparing educational materials to assist clients’ governmental relations teams to advocate program and reimbursement changes based on policy-based rationales.
  • Performing due diligence analysis of existing governmental reimbursement streams to assist providers in mergers, acquisitions, competitive bidding situations and divestitures.
  • Identifying and advising providers on opportunities to restructure operations to ensure each provider is properly reimbursed.
  • Assisting institutional healthcare providers in several states to design, develop, secure federal approval for, implement and operate Medicaid supplemental payment programs that generate hundreds of million in annual reimbursement for the services these facilities provided to the low-income and needy population.
  • Helping providers respond to Medicare and Medicaid audit findings.
  • Performing Medicare and Medicaid cost report analyses and handling requests for re-openings and Medicare Part A Reimbursement Appeals.