Our Services
Consulting for the Full Range of Healthcare
Professional Provider Services (PPS) provides management and consulting services to hospitals, home health agencies, nursing homes, physician practices, third-party medical billing companies, malpractice insurers, laboratories, pharmaceutical companies, State Medicaid agencies, and community mental health centers throughout the country. We pride ourselves on our unparalleled experience in the healthcare field and on producing measurable results in a cost-effective manner.

PPS often serves as a liaison to the government on behalf of the healthcare provider. We tap into our reservoir of expertise and client commitment to resolve issues related to:

• Medicaid drug rebate issues including dispute resolution
• Pharma reimbursement and pricing issues
• Cost savers for State Medicaid agencies
• Medicare credit balance reports
• Negotiation of extended repayment agreements
• Delinquent installment payments and settlement withholds
• Cost report audit adjustments
• On-site audit requests
• Medical necessity issues
• Certificate of Need

PPS has extensive experience in assisting in the preparation of CON applications and representing clients in CON hearings. We also regularly serve as expert witnesses (reimbursement, financial and development) in CON contested case hearings.

Medicaid Rebate Program
Our experience in the Medicaid rebate program dates back to its inception. Our staff was responsible for overseeing national audits of State Medicaid pharmacy programs as well as complex audits of pharmaceutical manufacturers that participated in the Medicaid drug rebate program. We also have an unmatched level of experience in the historical development of CMS policy issues during the implementation of the Medicaid drug program and we maintain ongoing liaisons with key CMS staff. This combination of extensive experience and current information provides the basis for our reliable consultation.

We have an experienced cadre of real experts, former OIG senior management staff and CMS policy experts. Our competent, responsive employees know the Medicaid and Medicare drug programs and the problems associated with them, and they have the expertise to make recommendations that are compliant with the law and established polices.

We can assist you in assuring your AMP and BP calculations are compliant with established policies and law. We can also make sure you:

• Comply with the requirements of the Medicaid drug rebate program — and now Medicare
• Get meaningful responses from CMS
• Are not paying rebates on another manufacturer’s products for rebates billed using J-codes
• Not inadvertently reporting inaccurate drug category information (e.g., Single Source (S) v. Innovator (I))
• Effectively participate in rebate dispute resolution efforts
• Are following Corporate Integrity Agreements (CIAs) and Compliance programs

PPS will thoroughly assess your situation, whether it is a single issue or a comprehensive array of issues. After our thorough analyses, we will recommend options to help you develop and implement the solutions that meet your needs and remain in compliance with regulations, laws and established policies.

What PPS Offers Rx Manufacturers
The challenges facing the pharmaceutical industry have never been greater. Have you ever asked yourself any of the following questions?

• How do I comply with the various and sometimes confusing requirements of the Medicaid drug rebate program – and now, Medicare?
• Who do I contact at CMS? What if I get no response?
• What types of correspondence increase the likelihood of a meaningful response from CMS?
• How do I get to meet with the right officials at CMS?
• How do I know my AMP and Best Price data are accurate?
• Is my company missing out on strategies to ensure its pricing information and rebate processes do not result in improper and excessive rebates?
• J-code reporting problems — is my company paying rebates on another manufacturer’s products? How do I identify that? How do I fix it?
• Is my company inadvertently disadvantaging itself by reporting innacurate drug category information (e.g., Single Source [S] v. Innovator [I]?
• Is the playing field level for my company in terms of compliance with CMS policies?
• How can I find out about supplemental rebate agreements? Pharmacy Plus waivers? Timely information on States’ Rx initiatives?
• How do I prepare for or respond to an OIG audit of my pricing data? Calculations of AMP and BP? Recalculations? Rebate payment reviews?
• How do I ensure that my company is effectively participating in rebate dispute resolution efforts?
• Who will intercede on my behalf in liaison efforts with CMS?With States?
• How will the new Medicare Rx benefit affect my company?

Business Turnaround
In our rapidly changing global economy, the healthcare business has undergone a revolution. Systems, procedures and management are constantly being advanced and overhauled. The organizational structure, policies, and technology are more complex than ever before. The only thing that seems to remain constant is change.

In the healthcare industry, change is generally a good thing. Advances in technology can improve the length and quality of life for many people. But the frequency and magnitude of all the changes affecting every part of the healthcare business can wreak havoc on your organization. Changing markets, financial pressures, and corporate reorganizations can negatively affect the value and public perception of your business, placing it in very real jeopardy.

Businesses that have the strength to acknowledge problems and deficiencies and hire professional turnaround experts to restore their business to its potential will succeed again. Engaging professionals to treat an unhealthy organization is just like going to the doctor when you're ill. Acknowledging the problem, treating the symptoms, identifying the underlying causes, curing the ailment and preventing a recurrence are required in both cases.

Our team at Professional Provider Services is uniquely qualified to help your healthcare organization implement a business turnaround and restore your corporation's value. With more than 150 years of collective experience in the healthcare industry, we understand the field and all of its challenges. As a result, we can help restore your business to profitability.