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Medicare › Out of Network Provider › Health Care Providers

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

Arnall Golden Gregory LLP

The Caris MPI Decision: A Potential Turning Point in Out-of-Network Litigation Against Medicare Advantage Organizations

Arnall Golden Gregory LLP on

Nonparticipating providers have often struggled to recover fair reimbursement from vertically integrated, well-resourced Medicare Advantage Organizations (“MAOs”) through out-of-network litigation. The pattern is...more

Hendershot Cowart P.C.

Texas ER Physicians Sue Insurer for Underpayment – Thousands of Claims at Stake

Hendershot Cowart P.C. on

An appeal brought before the Texas Supreme Court could unleash a wave of legal action by out-of-network ER physicians pursuing insurers for underpayment of claims. Unlike in-network providers who negotiate reimbursement...more

Blank Rome LLP

Ninth Circuit Deals Significant Setback to Medicare Advantage Out-of-Network Providers

Blank Rome LLP on

In a blow to out-of-network providers pursuing underpayments from Medicare Advantage plans, the U.S Court of Appeals for the Ninth Circuit Court of Appeals recently held in Global Rescue Jets, LLC v. Kaiser Foundation Health...more

Jackson Lewis P.C.

AMA and AHA Seek to Enjoin Certain Provisions of the No Surprises Act’s Implementing Rule

Jackson Lewis P.C. on

In December 2020, Congress passed the “No Surprises Act” (NSA) as part of the Consolidated Appropriations Act of 2021. The NSA applies most commonly in situations where a patient receives out-of-network medical services from...more

Rivkin Radler LLP

[Webinar] Lunch-and-Learn Series: Recent Developments in Telehealth: For the Pandemic and Beyond - November 18th, 12:00 pm - 1:00...

Rivkin Radler LLP on

Please join us as Rivkin Radler Partner Eric D. Fader provides an overview of changes in the provision of telehealth services and federal and state regulation of them, since the beginning of the COVID-19 pandemic. New rules...more

Moritt Hock & Hamroff LLP

The No Surprises Act: Congress Takes Aim at Surprise Medical Bills

Moritt Hock & Hamroff LLP on

In the closing days of 2020, Congress passed federal legislation aimed at protecting patients against surprise medical bills and facilitating payment dispute resolutions among providers and insurers. Slated to take effect on...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor: Eighth Circuit Upholds Payment for Out-of-Network Air Ambulance Flight at 150 Percent of Medicare Rates

Hinshaw & Culbertson LLP on

In Mitchell v. Blue Cross Blue Shield of N.D., 2020 U.S. App. LEXIS 8818 (8th Cir. Mar. 20, 2020), the Eighth Circuit upheld the payment of 150% of Medicare rates for an out-of-network air ambulance flight, although the...more

Baker Donelson

Surprise Medical Billing Gains Momentum in Washington

Baker Donelson on

Over the last few weeks, President Trump and lawmakers in both the House and Senate have taken several steps to protect patients from surprise medical bills, the latest signs of bipartisan momentum to address the issue this...more

Fox Rothschild LLP

NJ Medical Practices Must Update Patient Disclosures To Comply With Out-Of-Network Billing Law

Fox Rothschild LLP on

The New Jersey Department of Banking and Insurance (DOBI) has issued an 18-page Bulletin on implementation of the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act by health care...more

K&L Gates LLP

K&L Gates Triage: Triage in 2018: Health Care Topics to Watch in the New Year

K&L Gates LLP on

We expect 2018 to be another year of rapid change within the health care industry. In this episode, Mary Beth Johnston highlights some of the key topics that the health care practice group will monitor in the coming year,...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

Buchalter

California Clamps Down On Surprise Out-Of-Network Bills

Buchalter on

On September 23, 2016, Governor Brown signed AB 72, California’s surprise out-of-network law. The bill protects patients who seek care at an in-network facility from balance billing by individual health care providers who are...more

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