Healthcare Reimbursement
Healthcare Reimbursement
Our Healthcare Reimbursement Team has over 30 years of experience counseling provider clients, including large health systems, on health care reimbursement matters related to Medicare, Medicaid, and other payers. We focus on healthcare reimbursement rules, contract interpretation, appeals and enforcement issues that are critical to the financial health of all healthcare businesses.
Our team assists clients in determining if they have run afoul of conditions of payment or participation and, if so, advises of the implications, recommending appropriate action and guiding them through the process. When payors improperly deny payment to clients, we pursue resolution when appropriate as well as appeals before administrative agencies, including ALJs, the Provider Reimbursement Review Board and the CMS Administrator, and the courts. We assist providers in various areas of health care payment, including provider-based status, co-location, wage index, bad debt and medical education.
Our attorneys monitor annual Medicare payment rules issued by the Centers for Medicare & Medicaid Services (CMS) and changes to reimbursement and billing policies, as well as congressional activity related to billing and reimbursement and implementation by the relevant agencies. We support clients on reimbursement-related programs, including the federal 340B drug pricing program, and emerging regulatory and reimbursement issues, such as implementation of the No Surprises Act and COVID-19 relief payments under the Provider Relief Fund. We also work with clients on Medicaid payment matters and issues related to commercial payors.
In addition to our deep experience, we have strong relationships inside government agencies. Several of our attorneys have previously served in government roles, which allows us to quickly connect with the right people. This level of access, knowledge and experience makes us a go-to choice for reimbursement matters and appeals. We solve issues before they become costly and problematic, helping clients avoid disruption so they can continue offering the highest quality patient care, stay ahead of competitors, and remain in harmony with payors.
Our Healthcare Reimbursement Team has over 30 years of experience counseling provider clients, including large health systems, on health care reimbursement matters related to Medicare, Medicaid, and other payers. We focus on healthcare reimbursement rules, contract interpretation, appeals and enforcement issues that are critical to the financial health of all healthcare businesses.
Our team assists clients in determining if they have run afoul of conditions of payment or participation and, if so, advises of the implications, recommending appropriate action and guiding them through the process. When payors improperly deny payment to clients, we pursue resolution when appropriate as well as appeals before administrative agencies, including ALJs, the Provider Reimbursement Review Board and the CMS Administrator, and the courts. We assist providers in various areas of health care payment, including provider-based status, co-location, wage index, bad debt and medical education.
Our attorneys monitor annual Medicare payment rules issued by the Centers for Medicare & Medicaid Services (CMS) and changes to reimbursement and billing policies, as well as congressional activity related to billing and reimbursement and implementation by the relevant agencies. We support clients on reimbursement-related programs, including the federal 340B drug pricing program, and emerging regulatory and reimbursement issues, such as implementation of the No Surprises Act and COVID-19 relief payments under the Provider Relief Fund. We also work with clients on Medicaid payment matters and issues related to commercial payors.
In addition to our deep experience, we have strong relationships inside government agencies. Several of our attorneys have previously served in government roles, which allows us to quickly connect with the right people. This level of access, knowledge and experience makes us a go-to choice for reimbursement matters and appeals. We solve issues before they become costly and problematic, helping clients avoid disruption so they can continue offering the highest quality patient care, stay ahead of competitors, and remain in harmony with payors.
Experience
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Representation of ProPath, the largest nationwide, fully physician-operated pathology practice in the U.S., on day-to-day healthcare reimbursement, compliance and regulatory...
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Representation of Physicians Group Laboratories (PGL), a laboratory service provider, on day-to-day healthcare reimbursement, compliance and regulatory advice.
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We obtained summary judgment on behalf of a group of 21 Tennessee physicians in federal litigation in Nashville challenging a...
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We represent one of the largest nonprofit hospital systems in the country in developing an out-of-network reimbursement strategy.
Experience
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Representation of ProPath, the largest nationwide, fully physician-operated pathology practice in the U.S., on day-to-day healthcare reimbursement, compliance and regulatory...
-
Representation of Physicians Group Laboratories (PGL), a laboratory service provider, on day-to-day healthcare reimbursement, compliance and regulatory advice.
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We obtained summary judgment on behalf of a group of 21 Tennessee physicians in federal litigation in Nashville challenging a...
-
We represent one of the largest nonprofit hospital systems in the country in developing an out-of-network reimbursement strategy.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Professionals
Name | Phone | |
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Kristin M. Bohl Member |
(202) 827-2987 | kristin.bohl@bassberry.com |
Justin K. Brown Member |
(615) 742-7725 | justin.brown@bassberry.com |
Jeffrey I. Davis Member |
(202) 827-7082 | jeff.davis@bassberry.com |
Lauren M. Gaffney Member |
(615) 742-7824 | lgaffney@bassberry.com |
Marianne C. Garner Counsel |
(901) 543-5720 | Marianne.garner@bassberry.com |
Leslie Demaree Goldsmith Member |
(202) 827-7083 | leslie.goldsmith@bassberry.com |
Anna M. Grizzle Member |
(615) 742-7732 | agrizzle@bassberry.com |
Travis G. Lloyd Member |
(615) 742-6208 | travis.lloyd@bassberry.com |
Christine M. Morse Member |
(202) 827-2986 | christine.morse@bassberry.com |
Dawn Perez-Slavinski Member |
(202) 827-7973 | dawn.perez-slavinski@bassberry.com |
Laurence B. Russell Counsel |
(202) 827-7085 | larry.russell@bassberry.com |
Danielle M. Sloane Member |
(615) 742-7763 | dsloane@bassberry.com |
Page Minton Smith Associate |
(615) 742-7706 | page.smith@bassberry.com |
Julia Tamulis Member |
(202) 827-2999 | jtamulis@bassberry.com |
Nesrin Garan Tift Member |
(615) 742-7861 | ntift@bassberry.com |
Publications
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August 28, 2024 | Firm Publication
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July 15, 2024 | The Compliance & Ethics Blog
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May 23, 2024 | Firm Publication
Upcoming Events
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October, 29, 2024 | Baltimore, MarylandAHLA Fraud and Compliance Forum
Past Events
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June 21, 2023 | WebinarBass, Berry & Sims
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March 8, 2023 | WebinarBass, Berry & Sims
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January 11, 2023 | WebinarStrafford
Media Mentions & Firm News
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September 5, 2024 | Bloomberg Law, Law360
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August 8, 2024 | Bloomberg Law
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June 17, 2024 | Law360 Healthcare Authority
Publications
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August 28, 2024 | Firm Publication
-
July 15, 2024 | The Compliance & Ethics Blog
-
May 23, 2024 | Firm Publication
Past Events
-
June 21, 2023 | WebinarBass, Berry & Sims
-
March 8, 2023 | WebinarBass, Berry & Sims
-
January 11, 2023 | WebinarStrafford
Media Mentions & Firm News
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September 5, 2024 | Bloomberg Law, Law360
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August 8, 2024 | Bloomberg Law
-
June 17, 2024 | Law360 Healthcare Authority
Contact
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
Notice
Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
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