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Hospitals › Billing › Health Insurance

Davis Wright Tremaine LLP

Two California Appellate Decisions Highlight Liability Risks Arising From Hospital "Conditions of Admission" Forms and Billing...

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In the ever-evolving world of healthcare billing, two recent reported California appellate court decisions, Naranjo v. Doctors Medical Center of Modesto and Dameron Hospital Association v. Progressive Casualty Insurance...more

J.S. Held

All Is Not What It Seems, Or When Is A Dollar A Dime?

J.S. Held on

Welcome to the strange and mysterious world of medical billing. If ever there was an industry in which the charges and the payments have no correlation, the medical industry is it. Medical billing can indeed be quite...more

Butler Snow LLP

Prior Authorization Reform in Healthcare: Winds of Change?

Butler Snow LLP on

Bob Dylan, winner of the Nobel Prize in Literature and one of the greatest American songwriters of all time, has effectively used wind as a metaphor in a number of songs he has written, each with its own distinct message....more

Proskauer - Health Care Law Brief

The Saga of the No Surprises Act Continues to be … Surprising

Proskauer - Health Care Law Brief on

We previously noted that the regulations implementing the No Surprises Act (“NSA”) appeared to be inconsistent with the NSA because they seemed to establish the qualifying payment amount (“QPA”) as the appropriate payment...more

Epstein Becker & Green

New York State Department of Financial Services Summarizes Changes Relating to Administrative Denials, Prior Authorizations, and...

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On March 10, 2021, the New York State Department of Financial Services (“DFS”) issued Insurance Circular Letter No. 4 (“Circular Letter”), which both explains modifications to the Insurance Law and the Public Health Law...more

King & Spalding

What Recent Class Action Rate Litigation Means for Hospitals

King & Spalding on

Legal challenges to hospital charges are increasing in both number and intensity with plaintiffs’ counsel continuing to file suits against hospitals around the country challenging the very existence and use of chargemasters...more

Saul Ewing LLP

New Jersey Enacts Out-of-Network Statute Affecting Hospitals, Surgery Centers, Physicians and Insurers

Saul Ewing LLP on

On June 1, 2018, New Jersey Governor Phil Murphy signed into law the “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” (the “Act”). In the preamble to the Act, the New Jersey...more

Sheppard Mullin Richter & Hampton LLP

‘Twas the Season to Contract? A Year-End Review of Network Negotiations and Billing Disputes

Sheppard Mullin Richter & Hampton LLP on

As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more

Stinson LLP

2017 OPPS Final Rule: Payment to Off-Campus Provider-Based Departments

Stinson LLP on

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the 2017 Medicare Outpatient Prospective Payment System (OPPS) Final Rule. One aspect of this rule is the implementation of payment decreases for...more

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