Lynn Shapiro Snyder, Leslie V. Norwalk, and Helaine I. Fingold, attorneys in the Health Care and Life Sciences practice of Epstein Becker Green, and Thomas E. Hutchinson, a Strategic Advisor for EBG Advisors, Inc., discuss the best strategies to use when navigating the complex coding, coverage, and payment regulations issued by the Centers for Medicare & Medicaid Services (CMS).

This video explores such strategies as:

  • Approaching CMS in advance of a proposed rule
  • Seeking clarification on guidance
  • Building relationships with CMS

This video features attorneys and professionals with decades of experience working with and for the Centers for Medicare and Medicaid Services (CMS).

HELAINE I. FINGOLD worked at the Center for Medicare & Medicaid Services' ("CMS's") Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group. As both a Senior Technical/Policy Lead and as the Acting Director, Rates & Benefits Branch, Division of Plan Management, Ms. Fingold was responsible for defining and interpreting requirements relating to the qualification of qualified health plans and stand-alone dental plans in both state and federally-facilitated exchanges, oversight of these plans, essential health benefits, and market-wide cost sharing limitations. From 2004 to 2012, Ms. Fingold worked in a range of capacities at CMS with responsibility for areas of the Medicare Advantage program, including plan application review and approval, application denials and appeals, contracting, plan surveillance, oversight, and marketing. She also is experienced in the Medicare Advantage and Prescription Drug audit and sanction process.

THOMAS E. HUTCHINSON served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion. This included all payment policy, systems development and implementation of the policies, validations of payments, and ensuring auditing compliance of these payments. The Part D risk adjustment model and the new (for 2012) Part C risk adjustment model were both developed under his leadership. Additionally, Mr. Hutchinson was the driving force behind the design and implementation of the Medicare Risk Adjustment Data Validation (RADV) audits.

LESLIE V. NORWALK served the Bush Administration as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). She managed the day-to-day operations of Medicare, Medicaid, State Child Health Insurance Programs, Survey and Certification of health care facilities, and other federal health care initiatives. For four years prior to that, she was the agency's Deputy Administrator, responsible for the implementation of the hundreds of changes made under the Medicare Modernization Act, including the Medicare Prescription Drug Benefit.

LYNN SHAPIRO SNYDER has over thirty-five years of experience at Epstein Becker Green, advising clients about federal, state, and international health law issues, including Medicare, Medicaid, TRICARE, compliance, and managed care issues. Her clients include health care providers, payors, pharmaceutical/device manufacturers, and those companies and financial services firms that support the health care industry. She publishes extensively and is a frequent speaker, particularly on topics related to health reform.

Epstein Becker Green’s close proximity to CMS headquarters in Baltimore enhances the efficiency of our services to clients.  Learn more about the solutions and services that we provide.

About Thought Leaders in Health Law

The Thought Leaders in Health Law® video series tracks the latest trends in multiple areas of the health care and life sciences industries, featuring attorneys and advisors from Epstein Becker Green and EBG Advisors.

Trouble viewing this video? Please contact us at thisweek@ebglaw.com and mention whether you were at home or working within a corporate network. We'd also love to hear your suggestions for future episode topics.

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