Reimbursement and Managed Care
The healthcare reimbursement system is extremely complex, with the rules governing healthcare reimbursement changing often. This complexity can make it challenging for health providers, as well as pharmaceutical, biotechnology and medical device manufacturers, to understand the rules and processes and keep up with the changes. Our job is to help make your job easier.
Compliance and Reimbursement Programs that Work
Our attorneys and government relations professionals fully understand the complexities of obtaining coverage, the necessity for proper coding and the requirements for obtaining appropriate reimbursement and can assist you with developing solutions to reimbursement issues. In fact, our team includes reimbursement attorneys who formerly represented Medicaid programs in New Jersey and Pennsylvania. Our healthcare attorneys often work closely with our federal government relations practice and our FDA practice.
Navigating the Reimbursement Maze
Our experienced healthcare attorneys have developed longstanding relationships with governmental payors to help you with all of your reimbursement issues. To provide you with current and appropriate information and counsel, we stay in close contact with:
- Federal agencies.
- Centers for Medicare and Medicaid Services (CMS).
- State Medicaid and Medicare offices.
- American Medical Association.
- Other governmental or quasi-governmental agencies.
Additionally, our healthcare lawyers have experience negotiating and helping to resolve disputes with commercial payors. Whether negotiating a managed care agreement, a pay-for-performance agreement, or patient home agreement, we have you covered.
In addition to handling routine health provider reimbursement issues, whether with governmental or commercial payors, we can help you with:
- Reimbursement matters related to new technology.
- Upper payment limit and disproportionate share programs for academic medical centers and faculty practice plans to maximize Medicaid reimbursement.
- Understanding the rules related to resident and intern supervision and reimbursement for graduate medical education.
- Reimbursement matters related to organ transplant program.
- Issues such as provider-based status, incident to billing, related parties, purchased diagnostic tests, telemedicine and global surgery billing.
- Written compliance plans with hospital policies and procedures that reflect federal and state statutes and regulations regarding direct and indirect graduate education reimbursement.
- ACOs and new payment programs.
- Negotiation of provider agreements.
- In and out-of-network reimbursement issues.
We provide assistance in following areas:
- Medicare and Medicaid Issues
- Managed care and other payor contracting issues
- Medicare enrollment, denials, and appeals