Medicare, Medicaid and Private Payment Issues

Health Law Group attorneys provide assistance to clients in connection with the spectrum of health care reimbursement and payment mechanisms. We assist health plans and providers in their dealings with governmental payors and related fiscal intermediaries, agents and carriers, including Medicare and Medicaid (through the Centers for Medicare and Medicaid Services) and TRICARE (through the Department of Defense).

The firm's healthcare payment practice includes:

• Assisting health plan clients in the development of Medicare and Medicaid risk plans, advising on related payment and benefit issues, and securing necessary CMS and state approvals.
  
  
• Assisting acute and long-term care providers in reforming the methodology by which Medicaid determines their payments, and advising facilities on Medicare and Medicaid Anti-Fraud and Abuse Amendments.
  
  
• Representing providers before the Provider Reimbursement Review Board (PRRB) with respect to general cost allocation issues, reasonable cost and prudent buyer matters, sole community provider status and new hospital status relating to prospective payment system (PPS) exceptions, cost depreciation recapture, and application of DEFRA (Deficit Reduction Act of 1984) basis limits on gain or loss in the sale of an institution.

Davis Wright Tremaine represents providers in the initial and continuing aspects of relationships with commercial third-party payors, including review of proposed managed care contracts and payment systems for both inpatient and professional services, and representation regarding payment issues that arise from such agreements.

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