Leveraging our capabilities and experience as one of the largest health care practices in the nation, our Managed Care and Payor Disputes team provides strategic, operational and litigation support to health care providers in all aspects of managed care and payor disputes.
Unlike many other firms, we do not represent health insurance companies so that we are always strategically aligned with our health care provider clients on these important issues.
We represent the full range of health care providers, including for-profit and non-profit hospitals and health systems, hospital-based ancillary providers, air ambulance companies, behavioral health companies, as well as laboratories, pharmacies and medical device companies.
Our skill set in this space includes a thorough understanding of all of the laws that affect commercial reimbursement, such as the ACA, ERISA and federal /state “surprise billing” laws. We are also well-versed on the business side of commercial reimbursement from both the provider’s and payor’s perspective based on extensive experience on a national basis evaluating providers’ revenue cycle processes, participating in provider-payor contract negotiations, and assessing large data sets to identify trended issues and escalation opportunities.
Our group of experienced health care trial attorneys are well-prepared to not only negotiate agreed resolutions of payor disputes but also bring them to final conclusion in court and arbitration when further action is required.
We constantly monitor managed care cases and trends around the country and share this information with our clients in training sessions, webinars/seminars and publications on a regular basis, including through our Health Care Reimbursement and Payor Dispute newsletter and our annual Reimbursement Institute.
The major categories of our practice include:
Strategic, Contracting and Operational Support
- In-network v. out-of-network strategies
- Patient billing strategies and processes
- Payor contract strategies and legal review, including value-based arrangements
- Payor engagement audits/processes
- In-house data analytics
- Legislative strategy and implementation
- Deal support/managed care due diligence
- Out-of-network underpayments and misclassified emergency claims
- COVID-19 reimbursement
- Challenges to new payor medical/billing policies and protocols
- “Surprise Billing” arbitrations
- Payor audits, recoupments, and offsets
- General denials/other in-network disputes
- Class actions