Healthcare providers and third-party payers know the existence of a contract does not always ensure that the payer-payee relationship will be without issues. Disputes can arise if the payer declines to reimburse the provider for a service on the grounds of that service is not covered or not medically necessary.
Our healthcare attorneys work with medical providers and third-party payers to assist in all aspects of contracting issues. We work on the front end to provide advice on the duration of the payer relationship, early termination options for both parties, the scope of services for which the payer agrees to provide payment for, reimbursements rates for services, and the providers right to appeal reimbursement denials as governed by state laws, and specific state law contracting requirements.
Our recent experience includes working with payers and health systems to structure payment withholds, incentive compensation pools, and sharing arrangements that are compliant with Federal and state laws and help achieve cost savings for all participants.
Our team also provides advice to providers with regard providing services under Medicare and Medicaid. We work to ensure our clients have a complete understanding of the applicable provider regulations before they execute a third-party payer contract to avoid liability and penalties under Federal or state laws.