Managed Care & Medicare/Medicaid Reimbursement

We draft and negotiate commercial management care contracts, working to strike a reasonable balance between the payor’s desire to unilaterally define the terms of reimbursement (through elaborate policies, procedures, and now quality metrics) and the provider’s desire to receive reliable compensation for defined quality outcomes and/or services rendered.

Our attorneys are conversant with the Medicare Internet-Only Manuals (e.g., Claims Processing, Benefit Policy, Program Integrity, etc.), National and Local Coverage Determinations, and MLN Articles, as well as the Connecticut Medicaid program regulations and Provider Bulletins. We use these resources to advise our clients and to represent them in disputes with payors, typically regarding patterns of improper denials.