By Barbara R. Fallon
The good news is surgery was successful, the medical plan was effective, rehabilitation complete and the patient has returned to normal activities of daily living. The bad news is the provider’s payment is outstanding and either lingering on the books or moving to bad debt due to complexities of the reimbursement system. Worse yet, payment was outright denied due to contractual, clinical, third-party liability, ERISA irregularities, workman’s compensation or other medical/legal disputes.
Abril Law, headquartered in Miami, is a boutique law firm with a major focus on healthcare reimbursement. The experienced firm, founded by Jorge Abril, has focused on the healthcare revenue cycle for more than three decades, to avoid and resolve reimbursement disputes.
Engaged and Knowledgeable Team
Managing Partner Jorge Abril’s passion for health care began as an undergraduate student working for critical care physicians. That exposure as a college student was the genesis for opening Abril Law in 1991 to concentrate on healthcare reimbursement, managed care litigations, and post-judgement remedies. Since then, the firm has successfully advocated for local, regional and national clients remedying revenue cycle matters.
Abril is a recognized authority on consumer protection and patient privacy statutes, and a frequent lecturer on related issues including the Fair Debt Collection Practices Act (FDCPA) and its state counterparts.
Trevor Biglin is an Abril Associate with primary focus on the healthcare reimbursement sector representing acute care, rehab, physician and behavioral health providers. He described the benefits of a boutique firm in terms of size and specialty expertise.
“We are on a first name basis with our clients, their revenue cycle teams and in-house counsel. They benefit from our niche focus of the revenue cycle environment and our personal familiarity with their particular provider specialty whether they are a single practitioner or multi-site facility. We know the law as it applies to their specific needs,” he explained, “and practice with a breadth and depth of knowledge.”
The firm regularly provides counsel on timely filing of claims, coding errors, clerical processing or prior authorization policies that trigger potential denial and litigation red flags.
According to Biglin, “With guidance on internal policies and procedures we can help clients – and their patients – avoid missteps that can result in litigation or help them attain a more timely resolution.”
Because South Florida is a geographic draw, tourism mecca, and academic medical hub with a diverse multicultural international core, there are some unique aspects patients present that need to be addressed to smooth the compensation process and avoid claim denials for clients. This may include analysis of a variety of insurance contractual terms, advice on social security documentation status, language barriers and out of network provider technicalities.
Experience and Expertise
The Abril Law team attorneys and on-call resources all have experience with the challenges and advantages of healthcare reimbursement in the sunshine state to assist clients during the early stages of the patient in-take process. Early intervention can avoid unnecessary claims aging resulting in lower collection rates and denials.
Like the firm’s founder, Biglin had his personal interest in helping others instilled at an early age from family members who were social workers. Initially he studied business administration and marketing and worked in the corporate world for several years. His desire to practice law motivated him to earn his JD from University of Miami where he graduated cum laude. His business skills support interpretation and communication of the ‘non-clinical realities’ of the clinical practice landscape (not often addressed in medical school) and cultivate an informed business-based guide in his clients best interests.
The Abril practice strategy is based on an understanding of business challenges and revenue needs.
“Our clients can rely on a responsive and collaborative relationship with the revenue offices in rural, urban or hospitality-based settings. We analyze contractual arrangements ranging from national managed care organizations to CMS guidelines and international travel insurance carriers in efforts to ensure correct coding and claims procedures up-front. This can reduce bad debt and avoid labor intensive litigation that can drag on and be detrimental to the bottom line. Also, from experience negotiating with self-pay medical debtors we are aware of and sensitive to their situation. We help providers draft clear documents to effectively enable future patients to better understand payment procedures and financial obligations,” Biglin explained.
Finally, the boutique firm has a strategic recruitment pipeline to attract a reservoir of qualified legal talent to help manage specific legal issues to build and maintain the firm’s reputation for championing the intricacies of healthcare reimbursement.
For more information, email tbiglin@abrilaw.com or call (305) 373-0901.
