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Research Basics for Medicare Reimbursement Issues


Level: Intermediate
Runtime: 63 minutes
Recorded Date: March 02, 2022
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Agenda

  • Common Medicare Reimbursement Issues
  • Primary and Secondary Sources of Authority
  • Research Techniques
  • Other Tips and Advice for Challenging Situations
  • Hypotheticals
Runtime: 1 hour, 3 minutes
Recorded: March 2, 2022

For NY - Difficulty Level: For both newly-admitted and experienced attorneys (transitional)

Description

This presentation will cover the nuts and bolts for researching issues related to Medicare reimbursement.

This program was recorded on March 2nd, 2022.

Provided By

American Bar Association
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Panelists

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Jesse D. Hale

Member
Sutin, Thayer & Brown

JESSE D. HALE practices primarily in the areas of health law, real estate, and commercial litigation. Jesse is a graduate of the University of New Mexico School of Law.

As a member of Sutin’s health law team, Jesse represents a variety of healthcare providers, from small practices and dental offices to hospitals, nursing homes, and FQHCs. He advises and represents healthcare clients in regulatory and compliance matters, fraud and abuse, False Claims Act (FCA) and New Mexico Fraud Against Taxpayers Act (FATA) matters and litigation, government investigations, billing and payment issues, payor auditing, credentialing, licensing, contract formation, and purchasing and procurement.

In his commercial litigation and real estate practice, Jesse represents individuals and businesses in commercial and real estate matters, including lease formation and negotiation, litigation regarding lease disputes, terminations and defaults, and commercial litigation.

Jesse is a native of the North Valley of Albuquerque, New Mexico. Before law school, Jesse was active in local and national politics, serving as a member of U.S. Senator Tom Udall’s 2008 Senate campaign staff in New Mexico and official staff in Washington, DC. During law school, Jesse served as a board member for the Association of Public Interest Law and the student chapter of the American Civil Liberties Union of New Mexico. Jesse also served as a research assistant for Professor James (Jim) Ellis, working with a team of student research assistants, professors, Professor Ellis, and practicing attorneys in preparing a petition for writ of certiorari to the United States Supreme Court on behalf of a death row inmate in Georgia. When he’s not practicing law, Jesse enjoys spending time with his wife and three young boys, cooking for his family and friends, and watching and playing soccer and basketball.

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Kyle Brierly

Associate
Athene Law

Kyle Brierly is an associate at Athene Law who draws upon his rich and varied experience as an attorney working within the U.S. Department of Health and Human Services (HHS) and elsewhere in the federal government. His practice focuses on reimbursement issues, regulatory compliance and healthcare policy.

? Prior to joining Athene Law, Kyle served as an attorney-advisor at the HHS Departmental Appeals Board (DAB) in Washington, D.C. He most recently served as a Team Lead in the DAB’s Civil Remedies Division, reviewing appeals by providers, such as hospitals, nursing homes, physicians, home health agencies and clinical laboratories. In this capacity, he became intimately familiar with the adjudication of federal enforcement actions brought by the Centers for Medicare and Medicaid Services and the HHS Inspector General against providers. ?

Kyle previously served in the DAB’s Appellate Division. In this capacity, he supported the appellate review of disputes involving the Medicare and Medicaid programs. He was the primary drafter for numerous final Agency decisions, rulings and orders. ?

Prior to this appointment, he served in the DAB’s Tobacco Division focusing on issues related to the Food and Drug Administration’s tobacco control program.

?Kyle began his tenure with the Federal Government as a Presidential Management Fellow at the U.S. Department of Agriculture, Food Safety and Inspection Service.

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Jessica L. Gustafson

Founding Shareholder
The Health Law Partners, PC

Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. Ms. Gustafson represents hospitals, health systems, hospices, home health agencies, physicians and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Bar Association (ABA) Health Law Section, American Health Law Association, and Michigan Bar Association Health Care Law Section. She is actively involved in the ABA Health Law Section, serving as a Council Member, Co-Chair of the 2022 Physicians Legal Issues Conference and as a Vice-Chair of the Editorial Board of the publication ABA Health eSource. She also serves as the Chair of the Advisory Board to the American College of Physician Advisors (ACPA).

While in law school, Ms. Gustafson served as a member of the Wayne Law Review Editorial Board as a Senior Articles Editor. She also served as a judicial intern to the Honorable Robert H. Cleland, United States District Court, Eastern District of Michigan.


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