Managed care continues to have a tremendous impact on health care. Our health law practitioners provide a full range of services related to managed care arrangements including all aspects of HMO and PPO development, acquisition and sale, managed care joint ventures, independent practice associations (IPAs), and physician-hospital organizations (PHOs).
Our services include:
- Determination of appropriate structures and business forms
- Preparation of contracts with providers and payors
- Preparation of contracts with Medicare and federal employees
- Review of fraud and abuse, Stark, and reimbursement issues
- Insurance regulatory compliance and other state department of insurance matters
- Securities exemptions, offerings and registration matters
- Drafting and negotiating managed care contracts (e.g., Preferred Provider Arrangements, Participating Provider Agreements, Network Access Agreements, etc.)
- Form filings with state departments of insurance
- Administrative proceedings before state departments of insurance
- Development of internal policies and procedures for HMOs, PPOs, and other health insurers (e.g., utilization review, internal appeal and grievance procedures, etc.)
- Counsel on federal regulatory law impacting health insurance and managed care (e.g., HIPAA, ERISA, COBRA and Medicare Part D)
- Representing managed care clients in mergers and acquisitions
LOUISVILLE, Ky.—The American Bar Association (ABA) Health Law Section has ranked Stites & Harbison, PLLC in 5th place in its Ninth Annual Regional Top 10 Law Firm Recognition List for the South for 2020-21.
In December 2020, Congress signed into law the No Surprises Act (NSA) addressing surprise medical billing. Specifically, the NSA prohibits out-of-network health care providers and facilities from balance billing certain commercially insured patients in certain circumstances.
The federal No Surprises Act (the “NSA”) requires all healthcare service providers to provide accurate and reliable cost estimates (Good Faith Estimates) to patients paying cash for services. The NSA’s Good Faith Estimate requirement has not received the media or industry press enjoyed by the balance billing prohibitions applicable to out-of-network (“OON”) emergency services providers, OON ancillary service providers at in-network facilities, and OON air ambulance providers, but may actually be the biggest surprise in the NSA.