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Polsinelli’s Health Care Reimbursement team helps providers protect the revenue their organizations depend on. With one of the largest health care reimbursement teams in the country, our attorneys advise providers on reimbursement strategy, payment disputes, provider enrollment, coverage and payment issues and the structural and operational decisions that determine how they get paid. We partner with providers across the health care industry so they can focus on delivering quality patient care and growing their organizations.

We work closely with the Polsinelli’s Health Care Litigation, Mergers and Acquisitions, FDA, and Public Policy teams when payment issues intersect with disputes, transactions, advocacy or market access strategy. Our integrated approach supports clients in addressing reimbursement issues wherever they arise — including litigation and administrative appeals, reimbursement-sensitive transactions, legislative and regulatory advocacy, and strategies for securing coding, coverage and payment for novel treatments, technologies and devices.

Experience Across the Health Care Reimbursement Landscape

Our attorneys bring decades of focused reimbursement experience to the payment decisions that affect a provider’s business at every stage. We understand how the rules developed, how they apply in practice and how to help clients find workable answers without creating new risk.

We regularly advise on:

  • Medicare and Medicaid coverage, billing and payment rules, including Medicare Advantage and Medicaid managed care issues
  • Government and commercial payor coverage and payment guidelines, including TRICARE, Veterans Affairs (VA) and ACA/Exchange plans and employer group health plans
  • Payment models and reimbursement structures, including CMMI innovation models, value-based care, clinical alignment, pay-for-quality and prospective payment systems and bundled payments
  • Commercial payor negotiations and contracting
  • Prepayment and post-payment audits, recoupments and appeals
  • Overpayment analysis, reporting and repayment
  • Provider-based status and associated billing rules
  • 340B compliance and disproportionate share hospital (DSH) qualifications
  • Telehealth licensing, coverage and reimbursement
  • Provider Reimbursement Review Board (PRRB) appeals
  • Graduate Medical Education (GME) and Indirect Medical Education (IME) reimbursement compliance
  • Mental health parity and behavioral health reimbursement
  • Reimbursement issues arising in mergers, acquisitions, affiliations and other transactions
  • State licensure issues affecting reimbursement
  • Medicare and Medicaid enrollment, revalidation, suspension, revocation, termination and corrective action matters
  • Engagement with CMS and state Medicaid agencies on complex reimbursement issues
  • Implementation of new legislation, regulations and subregulatory guidance

Representative health care clients include:

Related Capabilities
340B Drug Pricing ProgramHealth CareReimbursement Audits & Disputes