King & Spalding attorneys and consultants have decades of experience in understanding the intricacies of the healthcare industry and obtaining coverage, coding and appropriate reimbursement for our provider and pharmaceutical/biotech and medical device manufacturer clients. We pride ourselves in our in depth knowledge of the reimbursement problems faced by our clients and developing cutting edge strategies to solve these problems.
Our team members have longstanding relationships with key policymakers in Congress, the Centers for Medicare and Medicaid Services (CMS), other federal agencies, including the Office of the Inspector General and the Department of Justice, state Medicaid offices, the American Medical Association, and other governmental or quasi-governmental agencies.
On healthcare reimbursement issues, we often work closely with our healthcare Government Relations, Government Investigations, and FDA & Life Sciences lawyers. Therefore, team members include former Members of Congress and former key staff of current Members of Congress, former counsel at CMS and FDA, a former Associate Deputy Attorney General at the Department of Justice, a former in-house industry reimbursement expert, and a physician who was the former Vice President and global Chief Medical and Technology Officer at a major device manufacturer.
Recognitions
Our team members regularly speak at conferences on reimbursement issues sponsored by organizations such as the American Health Lawyers Association and AdvaMed. Team members also include past Presidents of groups such as the American Health Lawyers Association and the Georgia Academy of Healthcare Attorneys. Several of our lawyers also have been recognized in Chambers USA Guide to America’s Best Lawyers, Who’s Who in America and similar listings.
Areas of Expertise
- Assisting clients to obtain CPT codes through the AMA and temporary and permanent HCPCS codes through CMS.
- Working to institute or revise national coverage decisions and local medical review policies for cutting edge procedures, drugs, biologics, or medical devices.
- Challenging Medicare reimbursement policies in court proceedings.
- Representing hospitals and other providers before the Provider Reimbursement Review Board.
- Providing strategic planning on coverage, coding and reimbursement issues for pharmaceutical, biotech, and medical device companies.
- Advising academic medical centers and manufacturers on coverage and reimbursement issues associated with clinical trials.
- Reviewing provider reimbursement policies and services and how these policies and services are described on websites and other promotional material.
