Polsinelli’s health care team includes attorneys with experience in every segment of the market for health care payment. Coupled with the deep bench of reimbursement experience held by those in the Polsinelli Reimbursement Institute
, our managed care and payor relations attorneys are uniquely equipped to navigate the complex world of payor contracting and reimbursement to support a wide range of health care providers.
Our managed care and payor relations team has specific and in-depth knowledge of contract and industry reimbursement methodology for the full spectrum of providers including:
- Health systems: hospitals, academic medical centers, and children’s hospitals
- Physician groups in every specialty, including multispecialty and staff model practices
- Senior housing and long term care facilities
- DME suppliers
- Dialysis providers
- Home health and hospice
- Infusion providers
This knowledge allows us to provide counsel on all aspects of proposed contract reimbursement, both as applicable to the individual provider and as consistent with the industry. Our attorneys also have direct experience with health care payment gained from working in house for both health care providers and large private payors.
Although managed care contracting historically has revolved around private health plan contracts, our group of attorneys has experience with the entire range of payors who may present a contract to a health care provider, including:
- Medicare Advantage plans
- Medicaid managed care plans
- Specialty payors (dental, vision)
- Provider-sponsored plans
- TriCare administrators
- Veterans Administration
Our attorneys partner with a health care provider’s business executives, contract managers, and revenue cycle teams to negotiate favorable payor contracts, assist with implementation of the payor billing relationship, appeal underpayments and denials, and manage revenue flow. We have extensive experience in navigating credit balances, overpayment refunds, and state law escheat issues, and in working with consultants to resolve such issues as payment relationships mature.
Should any payor relationship hit rocky ground, our managed care attorneys partner with our Payor Disputes team to manage disputes from the first denial or repricing through appeal, arbitration, and litigation. We have experienced litigators and arbitrators with years of experience in managing and resolving payment disputes across the industry. Should a payor relationship terminate – or should a provider choose not to contract for any reason – we have broad and deep knowledge of out of network reimbursement to support that type of reimbursement stream management as well.