Reimbursement

Reimbursement conflicts are an all-too-common problem in the U.S. healthcare industry, for several reasons: healthcare services are more often than not provided before payment is received; the billing and reimbursement process between healthcare providers and insurers is exceedingly complicated; and insurers and providers often disagree on the appropriate level of payment for services. The outcome of these conflicts can be critical to the bottom line of parties on both sides of the issue. A skilled and experienced lawyer can help both providers and payors address and resolve these disputes while maintaining important business relationships.

With one of the largest healthcare practices in the country, the lawyers at McGuireWoods have successfully represented a variety of clients throughout the United States. We work with healthcare providers, insurance companies, third-party administrators, and Medicare intermediaries and carriers on a broad range of reimbursement-related issues, including:

• Counseling healthcare providers on establishing and properly maintaining billing systems and processes for reimbursement
• Contracting with commercial payors
• Addressing reimbursement issues and disputes with a variety of private payors, as well as state and federal healthcare programs such as Medicare, Medicaid, TRICARE (formerly CHAMPUS) and the Children’s Health Insurance Program (CHIP)