Reimbursement Strategies and COVID-19: Getting Paid by Commercial Payers
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide guidance to healthcare counsel on revenue cycle issues caused by COVID-19, including issues arising from the passage and implementation of the CARES Act, changes to payment and other policies by commercial payers (including Medicare Advantage and Medicaid managed care payers), and the rapid expansion of telehealth. The panel will discuss strategies for improving payment from commercial payers in light of these issues.
Outline
- Pursuing payment for COVID-19 testing and treatment
- Prohibitions on balance billing
- CARES Act-initiated changes to payments for COVID-19 patients and application to commercial payers (including ERISA payers)
- Payer policies related to COVID-19
- Telehealth issues and strategies
- COVID-19 issues under Medicare Advantage and Medicaid managed care payers
- Patient mix challenges arising from patients losing employer-based coverage
Benefits
The panel will review these and other key issues:
- How will reimbursement from commercial payers change because of COVID-19?
- When can cost-sharing be implemented?
- What are best practices to ensure appropriate payment?
Faculty
Marcia L. Augsburger
Partner
King & Spalding
Ms. Augsburger has more than 24 years of experience advising clients on a broad range of healthcare industry and... | Read More
Ms. Augsburger has more than 24 years of experience advising clients on a broad range of healthcare industry and other civil disputes and class actions. Her work for clients includes counseling, contracting and developing policies and procedures in healthcare-related areas such as HIPAA, EMTALA, coverage and reimbursement, health care reform measures, telemedicine, medical tourism, fraud and abuse, ERISA and workplace wellness programs.
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John C.J. Barnes
Partner
King & Spalding
Mr. Barnes specializes in managed healthcare arrangements. He advises clients on the structuring of risk-based managed... | Read More
Mr. Barnes specializes in managed healthcare arrangements. He advises clients on the structuring of risk-based managed care contracts (including capitation and shared savings arrangements), as well as traditional fee-for-service arrangements. Mr. Barnes also advises clients on contract terminations, network access disputes, and revenue cycle practices. Experienced in managed care contract negotiations, he frequently counsels healthcare clients on federal and state compliance, charity and indigent care, non-contract provider payment, contract termination and transition, business office practices, and other issues. Mr. Barnes often works with healthcare providers and provider combinations in managed-care risk arrangements, helping them to develop efficient, legally compliant business and operational structures.
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James W. Boswell, III
Partner
King & Spalding
Mr. Boswell is the Team Leader of the firm’s national Healthcare Team. His practice is devoted to handling... | Read More
Mr. Boswell is the Team Leader of the firm’s national Healthcare Team. His practice is devoted to handling litigation and investigations on behalf of healthcare industry clients. Mr. Boswell has particular expertise in handling managed care litigation on behalf of healthcare provider clients. He has also served as counsel in False Claims Act lawsuits in Georgia, Mississippi, Nevada, New York and Texas. An experienced healthcare litigator, Mr. Boswell regularly handles jury trials, administrative hearings, arbitrations and appellate arguments regarding specialized healthcare issues.
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Amanda L. Hayes-Kibreab
Partner
King & Spalding
Ms. Hayes-Kibreab specializes in complex business litigation, arbitration and dispute resolution on behalf of... | Read More
Ms. Hayes-Kibreab specializes in complex business litigation, arbitration and dispute resolution on behalf of providers, with an emphasis on managed care litigation. As a healthcare litigator, she has extensive experience managing large multi-party, multi-million dollar disputes, litigating business contract and tort disputes, prosecuting and defending actions brought by large healthcare payors against hospital providers, heading up international white collar crime investigations for global healthcare device manufacturers, and providing advice on healthcare law and reform topics. Ms. Hayes-Kibreab represents hospitals and hospital systems, provider groups, surgery centers, individual physicians, and other healthcare entities.
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