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health care Reimbursement is driving the current evolution of the industry.  Understanding reimbursement trends and changes can drive the success of a health care organization, and can allow them to change course, as needed, to avoid detrimental REIMBURSEMENT policies.  Failure to do so may challenge the success of a health care organization, or worse, threaten its very existence.

The reimbursement process can be long and arduous, and can change often.  Understanding the nuances of both government and private payor reimbursement is one of the greatest challenges that provider’s face in today’s quickly changing health care world.  Polsinelli boasts one of the largest health care reimbursement groups in the country with strong experience in all areas of reimbursement, across all provider types. From understanding byzantine coverage requirements to handling the most complex audits, our reimbursement team regularly assists providers in making sense out of one of the most convoluted areas of health care. Our experience includes:

  • Prospective guidance on compliance with Medicare, Medicare Advantage, Medicaid, Medicaid managed care plans, and other government health care plans;

  • Strategic advice on clinical alignment, pay for quality and bundled payments;

  • Assistance with payor disputes and audits;

  • Analyzing and reporting overpayments;

  • Counseling on Provider-Based Billing;

  • Navigating PRRB Appeals;

  • Assisting with 340B Compliance;

  • Managed Care contracting; and

  • Protecting revenue streams pre- and post-transaction.

Our team includes the former Deputy Director of Colorado’s Medicaid agency, former OIG counsel, multiple former Assistant U.S. Attorneys with experience in health care fraud, former in-house counsel, a licensed CPA attorney who served as an in house accountant for a hospital, several former consultants. Our team is familiar with all of the various administrative appellate venues and regularly works with CMS, Medicaid agencies, and payors to resolve complex reimbursement issues. We also have a strong Public Policy team that intimately understands health care reimbursement issues and works with our clients in pursuing legislative strategies to address their most pressing reimbursement needs.

Polsinelli's Reimbursement Institute was created in an effort to continuously track changes within the industry as well as analyze the implications of those changes more easily and effectively. In providing a single source of news, information and other resources, the Reimbursement Institute is intended to serve as a valuable reference to Polsinelli clients as they navigate the channels of Medicare and Medicaid reimbursement.

About Polsinelli's Health Care Practice

The Polsinelli Health Care practice represents one of the largest concentrations of health care attorneys and professionals in the nation. From the strength of its national platform, the firm advises clients on the full range of hospital-physician lifecycle and business issues confronting health care providers across the United States.

Recognized as a leader in health care law, the firm was ranked as the 2018 "Law Firm of the Year" in Health Care by U.S. News & World Report's "Best Law Firms" for the second time in four years, and continues to hold the national Tier One ranking in Health Care Law. The practice is currently ranked by the American Health Lawyers Association as the largest health care practice in the nation (AHLA Connections, 2018), and is nationally ranked by Chambers USA 2018.

As one of the fastest-growing health care practices in the nation, Polsinelli has established a team that includes former in-house counsel of national health care institutions, the Office of Inspector General (OIG), and former Assistant U.S. Attorneys with direct experience in health care fraud investigations. Our group also includes current and former leaders in organizations such as the American Hospital Association. Our strong Washington, D.C., presence allows us to keep the pulse of health care policy and regulatory matters. The team’s vast experience in the business and delivery of health care allows our firm to provide clients a broad spectrum of health care law service.