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Attorney Spotlight

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Experience Spotlight

Primary Care Providers Win Challenge of CMS Interpretation of Enhanced Payment Law

With the help and support of the Tennessee Medical Association, 21 Tennessee physicians of underserved communities joined together and retained Bass, Berry & Sims to file suit against the Centers for Medicare & Medicaid Services to stop improper collection efforts. Our team, led by David King, was successful in halting efforts to recoup TennCare payments that were used legitimately to expand services in communities that needed them. Read more

Tennessee Medical Association & Bass, Berry & Sims

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Thought Leadership

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Thought Leadership Spotlight

Healthcare Transactions: Year in Review 2018Last year, CVS Health Corp. (NYSE: CVS) announced it would purchase health insurer Aetna Inc. (NYSE: AET) for $67.5 billion, a transaction that would be one of the biggest healthcare mergers in the past decade. The transaction raises an intriguing question: is this the beginning of a transformational shift in healthcare?

Recently, members of our healthcare group authored the Healthcare Transactions: Year in Review outlining 2017 M&A activity and drivers in the following hot healthcare sectors:

• Managed Care
• Hospitals
• Post-Acute Care—Home Health & Hospice
• Ambulatory Surgery Centers (ASCs)
• Healthcare Information Technology (HIT)
• Behavioral Health
• Physician Practice Management

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Operating Room

Managed Care Strategy & Disputes

Our Managed Care Team plays a unique and invaluable role in the healthcare industry. Many of the nation's largest healthcare law firms represent managed care companies in disputes with providers. In contrast, Bass, Berry & Sims primarily focuses on representing hospitals and other providers in their dealings with managed care companies and other payors.

We represent the universe of healthcare providers, including hospitals and health systems, ambulatory surgery centers, air ambulance companies, dialysis companies, specialty pharmacies, clinical laboratories, physician practice management companies, and physician practice groups.

The passage of the Affordable Care Act has affected all stakeholders in the healthcare industry – patients, providers, and payors. Given the finite resources and infinite demands on the healthcare system, payors have become more aggressive by creating narrow networks, taking hard positions in contract negotiations, adopting restrictive claims handling policies and procedures, and raising premiums, all while lowering payments to providers. In this environment, it is critical to understand every aspect of the healthcare provider's contractual and non-contractual relationships with managed care companies, as well as the laws that affect these relationships. Maintaining a viable business model may depend on having a clear understanding of these issues and a supporting business and legal strategy.

Invariably, disputes will arise. No matter the type of managed care dispute, we successfully navigate these disputes and aggressively negotiate, arbitrate, and litigate on our client's behalf.

The scope of our Managed Care practice includes:

  • Contract strategy and negotiation
  • Public relations strategies for communications with patients, employers, physicians, and media
  • Contract interpretation and disputes
  • UCR disputes
  • Out-of-network strategies and disputes
  • Responses to attempted recoupments and offsets
  • Analysis of laws affecting managed care matters, such as ERISA, prompt pay laws, any willing provider laws, and the Affordable Care Act

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