Reimbursement

Reimbursement

In the area of provider reimbursement, TD&P and its experts: 

  1. Provide consultation and expert testimony in disputes relating to determination of appropriate payment amounts and allegations of inappropriate denial of claims, billing practices, and out-of-network payment policies. 
  2. Perform statistical analyses to determine reasonable pricing and payment.
  3. Leverage TD&Ps in-depth knowledge of the health care industry, as well as its statistical and medical reimbursement expertise, to evaluate allegations of inappropriate denial of claims, up-coding, or fraudulent billing practices.
  4. Utilize statistical sampling to evaluate reimbursement allegations efficiently, including the assessment of whether there are systematic patterns in payments or claims.
  5. Analyze Medicare, Medicaid, and managed care health care claims data, as well as other key health care data sources, and rely on sound economic theory and accounting practices to evaluate class certification, merits, and damages questions.
  6. Utilize broad and deep experience with all facets of the health care industry.