We advise a broad range of healthcare providers—including hospitals, health systems, start-ups, and integrated provider networks—on structuring, negotiating, and managing payor relationships within an increasingly regulated reimbursement landscape. Our team is deeply experienced in handling transactional, operational, regulatory, internal and government investigations, and litigation matters across the full spectrum of managed care and value-based reimbursement.
Contract Negotiation and Reimbursement
No two commercial reimbursement contracts are the same, which is why Barnes & Thornburg’s Managed Care Reimbursement and Disputes team our structures and negotiates commercial payor agreements for providers of all types.
Whether analyzing fee-for-service contract terms or reviewing reconciliation language on sophisticated risk-based models, we relentlessly pursue opportunities to enhance our clients’ revenue cycle management, combat reimbursement compression, and avoid administrative delays – saving providers money and time.
Managed Care Disputes and Audits
With intricate contractual obligations and multiple parties, managed care disputes are often highly complex—particularly when they involve value-based compensation arrangements. Deeply experienced in provider-payor conflicts, our healthcare litigation attorneys deliver efficient and effective conflict resolution strategies, from negotiating pre-dispute settlements to pursuing a final resolution through trial or arbitration.
We represent clients in value-base model reconciliation, coding and reporting disputes, conflicts regarding the interpretation of capitated carve-outs and other division of financial responsibility (DOFR) matters, reasonable rate disputes, out-of-network issues, proceedings involving federal and state surprise billing laws, network termination, and pre-and post-payment reviews, settlements, and audits.
Managed Care Investigations
As Medicare and Medicaid reimbursement increasingly flows through managed care plans, providers face escalating reporting obligations and oversight and enforcement at health plan, federal, and state levels.
Our team, which includes former federal prosecutors, leverages years of industry experience to steer clients through SIU, RAC, UPIC, and DOJ investigations into Medicare Advantage risk adjustment scoring. We work to minimize operational disruptions while helping clients respond strategically and efficiently to government and payor investigations.
