Reed Smith’s Health Care Team counsels drug and device manufacturers, providers, and suppliers on reimbursement, coverage, coding and third-party payment issues. We apply our experience of working with Medicare, Medicaid, and other payors to achieve creative solutions through local, national, administrative and Congressional pathways.
Firm lawyers provide strategic advice on FDA approvals, data, and labeling before products and services are launched. We assist companies in managing the reimbursement issues associated with new drugs and devices at product launch. We work to obtain favorable coverage policies, new codes and improved payment through advocacy that blends scientific data, professional consensus, and legislative support. And we defend reimbursement practices and policies if challenged by federal or state enforcement agencies.
Our attorneys assist on every aspect of Medicare and Medicaid reimbursement, coverage and coding, including:
- Current Medicare DRG, HOPPS, RBRVS, and DMEPOS fee schedule payment
- CPT, HCPCS, and ICD-9-CM coding
- Local and national Medicare coverage and utilization restrictions, including private payer coverage such as under the Blue Cross and Blue Shield Technology Evaluation Center
- Proposed changes impacting capitation, fee schedules and per-diem payments
- Regulatory processes governing waivers and Medicaid managed-care programs
- Medicaid drug rebate programs
- Provider survey and certification requirements
We also counsel clients concerning reimbursement from private insurers and managed care plans, including HMOs. Firm lawyers have structured agreements that include capitation payments and other creative financial risk-sharing mechanisms.
Reed Smith is recognized around the world for its strengths in regulatory and commercial litigation. We have successfully litigated reimbursement matters in federal and state courts. Our attorneys have represented clients in payment cases before the Provider Reimbursement Review Board. We also help resolve disputes with private payors.
Hospitals, Skilled Nursing Facilities, Rehabilitation Facilities
Our attorneys advise on services subject to Medicare rules; work with providers and fiscal intermediaries to document compliance; and counsel on Medicare participation conditions such as those addressing governance and patients’ rights. We also help navigate the Medicare program’s provider-based status rules.
Members of our team have in-depth knowledge of the prospective payment systems that have been implemented for hospital inpatient, hospital outpatient, inpatient rehabilitation, and long-term acute care and skilled nursing facility services.