Most private health plans adopt payment policies that address a wide range of issues of importance to healthcare providers, such as the circumstances under which services are considered covered benefits and the requirements imposed on providers for obtaining authorization and payment. Providers have little or no say in the development of these policies. When a health plan changes a policy or adds a new one in the middle of a contract term, it can significantly undermine the financial assumptions that the provider made when it entered into the agreement. Recently, many national health plans have become more aggressive with the issuance of new payment policies, and providers are feeling the effects of these policies in the revenue cycle.
This roundtable will focus on contracting and litigation strategies for addressing health plan payment policies. The discussion will address:
- Recently-implemented health plan policies that are having a significant effect on providers, including advanced imaging site of service policies and policies targeting reimbursement for emergency services;
- Negotiation strategies to limit or eliminate a health plan’s contractual right to adopt adverse payment policies, or to make the provider whole if a newly-adopted policy will have a detrimental effect on the provider’s revenue;
- Litigation strategies to challenge a health plan’s implementation of a payment policy; and
- Strategies for quantifying the impact of these policies.
Wednesday, February 27, 2019
1:00 P.M. – 2:30 P.M. ET
If you have questions concerning this Roundtable Webinar, e-mail email@example.com.
CLE credit will be applied for in CA, GA, IL, NY, TX and, if needed, NC and VA. Attendees will receive a Uniform Certificate of Attendance via email approximately 30 days after the program to seek CLE credit in other jurisdictions. New York lawyers: This program is considered transitional and non-transitional in content. The interactive webinar format is synchronous and approved for all lawyers. King & Spalding LLP / 1180 Peachtree Street, Atlanta, GA 30309 | CA Provider # 10947.