Leveraging our capabilities and experience as one of the largest health care practices in the nation, Polsinelli’s attorneys advise providers in all aspects of disputes with health insurance payors and are buttressed by the deep well of reimbursement experience residing with our Reimbursement Institute.

Our team possesses particular experience in the areas of government and private reimbursement (including reimbursement in integrated delivery systems), and all aspects of the cycle of payment for health care services, from network contract negotiation through dispute resolution and audits. Polsinelli has experience managing disputes in all payor segments including Medicare Advantage plans, Medicaid managed care plans, Tricare, HMO plans and PPO plans.

The team’s experienced litigators partner with clients to successfully manage all stages of payor and reimbursement disputes, including administrative proceedings, appeals, arbitrations, mediations, district court litigations, audits and investigations. We also work regularly with clients to proactively devise and implement litigation avoidance strategies and counsel on a range of operational, regulatory and compliance matters.

Our attorneys routinely advise clients on matters including:
  • Representation of regional and national health care providers and suppliers, including hospitals, health care systems, skilled nursing facilities, ancillary providers, post-acute and durable medical equipment suppliers, in a range of matters related to Medicare reimbursement disputes before Medicare administrative contractors, state Medicaid agencies and the centers for Medicare and Medicaid Services (CMS).
  • Commercial payor disputes in arbitration and litigation.
  • Medicare audits and appeals, including issues related to statistical extrapolation and sampling.
  • Litigations with Medicaid Managed Care Organizations.
  • Negotiations with CMS contractors and other payors to remove or reduce prepayment reviews.
  • Litigation of numerous denials of payment and coverage cases across a broad spectrum of payor product lines.
  • Negotiation of Medicaid Managed Care contract issues on behalf of providers.
  • Serving as arbitrators and mediators in large-scale, multiple-state payor-provider disputes.
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