Over the past few years, changes in healthcare have driven fundamental changes in the relationship between providers and Managed Care Organizations. Medicare and Medicaid are front and center in these changes. Successful systems need new ways to look at managed care contract negotiations.
On May 18, 2023, Greenbaum attorney Neil M. Sullivan will be a
Whether or not explicit in the contract, all contracts have a mechanism for resolving disputes, the default being litigation. Left to their own devices, plaintiffs will select the forum most convenient and perceived to be most friendly to themselves that has jurisdiction over the parties and subject matter. The great majority of payer-provider contracts have
It all starts with the contract, but let’s face it … most consider provider-payer contracts obsolete on the day they are inked. A managed care contract is the quintessential tornado in a bottle, attempting to fix the terms and conditions that will apply for the course of the contract while the healthcare finance and delivery
The U.S. Departments of Health and Human Services, Labor, and the Treasury have issued final rules under the No Surprises Act, largely addressing the Independent Dispute Resolution process and downcoding.
As we previously reported, the U.S. District Court for the Eastern District of Texas issued a ruling that certain Centers for Medicare & Medicaid
A bill to prohibit healthcare providers from reporting unpaid medical debt to a collection or credit reporting facility is working its way through the New Jersey Legislature.
Assembly Bill 3802 (and its companion S2428) define “medical creditor” as any healthcare provider that provides healthcare services and to whom the consumer owes money for healthcare services,
Legislation revising the arbitration provisions of New Jersey’s Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act was signed into law by Governor Phil Murphy on July 29, 2022. New Jersey’s law was a predecessor to, and in some ways supplements, the federal “No Surprises Act.
As we noted in an earlier Client Alert,
Following the historic U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization overturning Roe v. Wade and Planned Parenthood v. Casey, attorneys and legal scholars are anticipating an avalanche of legal and practical issues emanating from the fact that there is no longer a federal constitutional right to obtain an abortion. Vesting
Economics 101 taught us that in a capitalist economy, prices are generally set by the market. This is also true, by and large, for healthcare services planned in advance – for providers in-network, insurers negotiate these rates. For providers out-of-network, healthcare consumers can agree to either pay the amount charged less the out-of-network reimbursement or