Areas of Expertise

DGA’s areas of expertise span the federal and state policy arenas.  Below are particular health care policy areas in which DGA specializes: 

» Assisted Living Facilities

» Durable Medical Equipment Prosthetics Orthotics Supplies (DMEPOS)

  • DMEPOS competitive bidding

» Elder Care Law

  • Abuse and Neglect
  • Long-term Care Planning and Contracting (assisted living facilities, independent living facilities, nursing homes, retirement communities, and more)
  • Medical Planning
  • Senior Care Planning

» Fraud, Abuse, Errors, and Waste

  • Anti-kickback law
  • Audits
  • Billing and coding
  • False Claims Act
  • Joint ventures
  • Medicare Administrative Contractors (MACs)
  • Recovery Audit Contractors (RACs)
  • Safe harbor regulations
  • Stark self-referral law
  • Third-party billing compliance programs (including provider responsibilities)
  • Third-party fee-for-service contracting
  • Zone Program Integrity Contractors (ZPICs) Audits

» Group Purchasing Organizations (GPOs)

» Health Care Benefits

  • DMEPOS
  • Home infusion
  • Medicare coverage (Part A, B, C, D, OTC, other)
  • Prescription drug
  • Specialty benefits

» Health Care Reform

  • Affordable Care Act (ACA) 2010

» Home Health Agencies

» Health Information Technology (HIT)

  • Electronic Health Records (EHR)

» Health Insurance Portability and Accountability Act (HIPAA)

  • Privacy and Security
  • Standards Development Organizations (SDOs)
  • Code sets:  CPT, HCPCS, other
  • Electronic Data Interchange (EDI) transactions:  NCPDP, X12

» Home Infusion

» Hospice

» Long-term Care Pharmacy

» Medicare and Medicaid Provider Enrollment

  • Change of Ownership Interest (CHOW)
  • Enrollment
  • Medicare Administrative Contractors (MACs)
  • National Provider Identifier (NPI)
  • Revalidation

» Medicare Coverage and Benefits Policies

  • Appeals

» Nursing Home Reform

  • Prospective Payment System (PPS)
  • Pharmacy services provider contract disclosure provisions

» Oncology

  • Outpatient billing and reimbursement, e.g., Intravenous Immune Globulin (IVIG)

» Pharmaceutical Manufacturers

  • Medicaid coverage
  • Patient Assistance Programs
  • Product code approval:  CPT, HCPCS, other

» Pharmacy Law

  • Home health care
  • HIV/AIDS
  • Long-term care
  • Managed care
  • Specialty pharmacy
  • Transplant pharmacy

» Physical Therapy

» Revalidation

» Specialty Imaging

  • Independent diagnostic imaging facilities (IDTFs)
  • Portable x-ray providers