Overview
Coverage and payment issues in the health care industry are extremely complex for many organizations. Epstein Becker Green has decades of experience representing health care clients in third-party coding, coverage, and payment/reimbursement issues from state and federal governmental sources.
We have many attorneys with in-depth knowledge about all types of government health programs. At the federal level, we assist clients with a full spectrum of federal health program issues, including Medicare, Medicaid, Tricare (formerly known as CHAMPUS), and the Federal Employees Health Benefits (FEHB) Program. At the state level, we assist clients with state Medicaid and other state rate-setting matters, state payor systems, and other state programs, such as high-risk pools for the chronically ill.
Our Government and Commercial Coding, Coverage, and Payment Group consists of attorneys who focus on government program coding, coverage, and payment/reimbursement matters; qualification for participation in federal and state health programs; and obtaining facility licenses and/or certificates of need. We also counsel clients on the requirements for operating and delivering health services to governmental programs and assist clients in maintaining corporate compliance with these highly regulated health programs.
Services to Meet Your Needs
Epstein Becker Green provides complete legal support for health care organizations related to third-party payors. Our services include:
- providing representation before the Medicare program, the Medicaid program, Tricare, the FEHB Program, and the U.S. Public Health Service;
- providing representation before state rate-setting boards and state payor systems;
- serving as due diligence counsel to determine a health care organization's compliance with government health program requirements;
- serving as legal counsel for qualification submissions for participation in federal and state health programs;
- preparing documentation and submissions for state facility licenses and certificates of need;
- providing comprehensive legal services regarding participation requirements in government health programs, including participation in the Medicare Advantage program and Medicaid managed care programs;
- appealing payment denials and overpayment determinations for providers and suppliers under all government health programs;
- providing legal reviews of new and proposed corporate structures for impact on eligibility for government payments;
- litigating disputed denials and payment methodologies;
- advising on pharmaceutical rebate and discount issues under state and federal rebate laws, including the Medicaid Drug Rebate Act/Veterans Health Care Act; and
- providing representation in connection with coding, coverage, and payment issues for new drugs, devices, or services.
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Insights
Insights
- PublicationsThe IRA: Reducing Inflation or Threatening Patient Access?2 minute read
- PublicationsFinal Medicaid Managed Care Rule Updates Requirements Regarding Access, Finance, and Quality17 minute read
- PublicationsCMS Finalizes Medicaid Access Rule: Significant Changes Ahead for HCBS Industry10 minute read
- PublicationsCMS Finalizes Rule Establishing Minimum Staffing Standards for Long-Term Care Facilities17 minute read
- Media CoverageJenny Nelson Carney Discusses Effects of Emergency Abortion Care Case Set to Go Before U.S. Supreme Court3 minute read
- Media CoverageHelaine Fingold Quoted in “3 Years In, 'No Surprises' Gets Mixed Reviews from Providers”2 minute read
- PublicationsFood Is Medicine: The Road to Universal Coverage2 minute read
- Firm AnnouncementsEpstein Becker Green Fuels West Coast Momentum with Six-Attorney Health Care Team6 minute read
- PublicationsAdvancing Interoperability and Improving Prior Authorization: No One Said It Would Be Easy!18 minute read
- Publications
Will Religious Freedom Claims Trump Public Health? Braidwood and HIV Prevention
2 minute read - Media CoverageRichard Hughes Quoted in “ObamaCare Faces Key Hearing After Texas Ruling”2 minute read
- BlogsVideo: Braidwood v. Becerra – Challenging the Affordable Care Act’s Preventive Services Coverage Provision – ...2 minute read
- Media CoverageRichard Hughes Quoted in “4 Argument Sessions Benefits Attys Should Watch in March”4 minute read
- Media CoverageRichard Hughes Quoted in “Affordable Care Act Preventive Services Under Threat: Previewing Braidwood Oral Arguments” ...4 minute read
- Media CoverageRichard Hughes Quoted in “Doc Pay Patch Could Emerge in Scaled-Back Health Package; Budget Talks Continue”2 minute read
- PublicationsEnsure Equity and Feasibility in Updating Meningococcal Vaccine Recommendations2 minute read
- Media CoverageHelaine Fingold Quoted in “No Surprises IDR Portal Is Back; Prepare for New Info Requirements”2 minute read
- PublicationsNew Coverage, Delivery, and Payment for Health-Related Social Needs Services Under New York’s Approved 1115 Medicaid ...13 minute read
- PublicationsSponsored Genetic Testing Programs: Compliance Considerations Following DOJ False Claims Act Settlement13 minute read
- PublicationsClinical Preventive Guidelines Should Foster Patient Access: A Reply to Killelea and Johnson6 minute read
- PublicationsHospital and MA Plan Considerations for CMS Final Rule to Remedy 340B Drug Payment Policy11 minute read
- Media CoverageRichard Hughes Quoted in “The RSV Shot for Babies Was Supposed to Save Lives. Then Nobody Could Get It.”13 minute read
- Media CoverageDavid Shillcutt Quoted in “4 Major Benefits Policy Developments from 2023”3 minute read
- BlogsPodcast: Health Equity – Behind the Buzzwords – Diagnosing Health Care2 minute read
- PublicationsMedicare Advantage, Part D, and More: Proposed Rule Outlines Significant Policy and Technical Changes for CY 2025 ...35 minute read
- PublicationsBraidwood v Becerra’s Vaccine Access Threat3 minute read
- Publications
In Genesis Case, South Carolina District Court Scraps HRSA Interpretation of “Patient” Under 340B Statute
9 minute read - Firm AnnouncementsEpstein Becker Green Announces 2024 Promotions6 minute read
- PublicationsPaving the Way for Prevention Over the Counter3 minute read
- PublicationsQuadrivalent vs Trivalent Influenza Vaccines: Not a Simple Switch2 minute read
- Media CoverageRachel Snyder Good Quoted in “'Devil's in the Details' of Biden's AI Health Plans, Experts Say”3 minute read
- PublicationsThe Task Force’s Latest PrEP Recommendation for HIV Is Just More of the Same2 minute read
- Media CoverageRichard Hughes Quoted in “Coverage, Supply Issues Dampen Promise of New RSV Immunizations”3 minute read
- PublicationsCMS Seeks Stakeholder Feedback About Medicare Transaction Facilitator Services for the Medicare Drug Price Negotiation ...4 minute read
- Media CoverageRichard Hughes Quoted in “An R.S.V. Shot for Infants Is in Short Supply. Here’s What to Know”4 minute read
- Media CoverageRichard Hughes Quoted in “Webinar Highlights Recommendations to Improve Disparities in CRC Screening”3 minute read
- PublicationsCalifornia Enacts Statute That Furthers Efforts to Move Toward a Unified Health Care Financing System11 minute read
- Media CoverageRichard Hughes Quoted in “RSV Vaccines Aren’t Covered by Medicare for These Vulnerable Groups”2 minute read
- Media CoverageRichard Hughes Quoted in “Opinion: It Shouldn’t Be So Hard for Older Adults to Receive the RSV Vaccine”2 minute read
- Media CoverageLesley Yeung Quoted in “Doctors Question Medicare Quality Program as More Face Steeper Penalties”2 minute read
- PublicationsRecent Developments in Federal and State Fraud and Abuse Investigations2 minute read
- Media CoverageHelaine I. Fingold Quoted in “The Medicare Advantage Marketing Problem and Where It’s Headed”3 minute read
- Media CoverageHelaine Fingold Quoted in “Reports of Cold Calling, False Promises Put Medicare Marketers on Alert”3 minute read
- Media CoverageRobert Wanerman Quoted in “Fight Over Medicare Pay Hinges on Primary Care”4 minute read
- Media CoverageRichard Hughes Quoted in “Federal Watchdog: One Quarter of HIV-Positive Medicaid Enrollees Missed Care”3 minute read
- PublicationsRichard Hughes, Devon Minnick Discuss Reforms of the US Preventive Services Task Force’s Processes3 minute read
- Media CoverageRichard Hughes Quoted in “New RSV Vaccines Aren’t Covered by Some Health Insurance Plans”3 minute read
- Media CoverageRichard Hughes Quoted in “Preventive Services Recommendation May Not Increase Injectable PrEP Access”3 minute read
- Media CoverageEpstein Becker Green Update Cited in “Physicians Could Be in Financial Danger with This Stark Law Change”2 minute read
- Media CoverageRobert Wanerman Quoted in “Hospitals Push Back on Safety-Net Payment Cuts”3 minute read