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.
Representation of ProPath, the largest nationwide, fully physician operated pathology practice in the US, on day-to-day healthcare reimbursement, compliance and...
Representation of Physicians Group Laboratories (PGL), a laboratory service provider, on day-to-day healthcare reimbursement, compliance and regulatory advice.
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.