Practice Areas & Industries: Baker, Donelson, Bearman, Caldwell & Berkowitz, PC

Practice/Industry Group Overview

Payment and reimbursement issues touch every sector of our health care practice. For instance, the success or failure of a health care venture is largely dependent on the ability of the venture to obtain payment in a timely manner. The Health Law Department attorneys at Baker Donelson are experienced with working with private health care plans, Medicare and Medicaid to assist our clients with these matters. Likewise, advising clients on payment and reimbursement issues represents a significant portion of our health care compliance counseling. Finally, with respect to payment appeals and provider audits, our attorneys have represented clients at every level of payment spectrum (i.e., contractor appeals, ALJ appeals, PRRB appeals and court appeals), including negotiating settlements with the Department of Justice and the Office of Inspector General.

There is significant overlap between reimbursement and an array of other areas of health law, including corporate compliance, white collar crime, and fraud and abuse. In addition, the multitude of health law issues likely to arise in any given transaction will greatly influence deal design. As a result, when it comes to transactions and business structuring, our experience in reimbursement and other areas of health law provides our clients with a single source of advice on how reimbursement and other health law issues impact their business objectives.

In this area of the law, our attorneys strive constantly to stay one step ahead of the constantly changing legal and regulatory landscape. Success in each endeavor requires us to work closely with our clients as well as legislators, administrative agencies and Medicare contractors. Our attorneys have obtained national recognition in this area of the law, including serving on national faculties regarding Medicare payment and reimbursement issues, serving in leadership positions within the AHLA and frequently contributing to legal publications addressing these issues.

Representative Matters

• Coordinated Medicare change of ownership (CHOW) events for multiple hospital and ancillary facility acquisitions, including 855 filings, certification surveys and cash flow considerations.
• Assisted providers and practitioners in obtaining initial enrollment in the Medicare program, including certification issues and complying with Medicare's conditions of participation (CoP).
• Assisted clients in analyzing structural options from the perspective of different reimbursement mechanisms (e.g., provider-based status, hospital within a hospital status, IDTFs, etc.).
• Assisted providers in consolidating Medicare provider agreements.
• Assisted a hospital provider in obtaining disproportionate share (DSH) payments for services furnished to residents in other states.
• Negotiated major payor contracts with most national plans on behalf of hospital systems, physician groups and ancillary service providers.
• Assisted a national biotech firm in seeking a National Coverage Decision for a new medical device.
• Assisted clients with responding to carrier probe audits, OIG investigations, and DOJ subpoenas related to Medicare and Medicaid payment issues, including cost report audits, the PATH initiative, the lab unbundling initiative, and the current investigation of PPS discharges/transfers.

Services Available