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Healthcare › Payor Contracts

Arnall Golden Gregory LLP

Ninth Circuit Publishes New Opinion Regarding Healthcare Provider Assignments and Reinforcing Broad Standing to Bring Suit Against...

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On January 10, 2024, the United States Court of Appeals for the Ninth Circuit published an opinion in the matter of South Coast Specialty Surgery Center, Inc., v. Blue Cross of California, which resolidified the Ninth...more

Manatt, Phelps & Phillips, LLP

Court Rules Provider’s Prior Authorization Calls with Payor Not a Binding Contract

Manatt, Phelps & Phillips, LLP on

In a decision important to health care payors and providers alike, a California Court of Appeal, in AToN Center, Inc. v. United Healthcare Insurance Company, et al., 93 Cal.App.5th 1214 (2023), agreed with a lower court...more

Quarles & Brady LLP

Amidst Ongoing Manufacturer Restrictions, 340B Covered Entities and Contract Pharmacies Get Creative

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Although 340B-participating covered entities likely don’t need the reminder, numerous manufacturers continue to significantly restrict 340B pricing available via traditional “bill to/ship to” contract pharmacy models, with...more

McDermott Will & Emery

VBC Symposium 2023 | Find Your Niche: Value-Based Models for Clinical Specialties

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During this session, Partner Jeremy Earl moderated a panel that collected insights on how specialists can participate in value-based care and the unique challenges specialists face in maximizing value-based care...more

Polsinelli

Health Care Reimbursement and Payor Dispute Update - September 2022

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Co-Location and the Provider-Based Rules – No News is…Good News? On July 15, the Centers for Medicare & Medicaid Services ("CMS") released the 2023 Outpatient Prospective Payment System proposed rule (“OPPS Proposed...more

Polsinelli

Health Care Reimbursement and Payor Dispute Update Special Edition - Year End Regulatory Review

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The end of 2021 brings positive indications of the continued acceptance of telehealth as an important clinical care approach post public health emergency (“PHE”). The Centers for Medicare and Medicaid Services (“CMS”), like...more

Troutman Pepper

Beyond the Label: FDA Addresses Permissible Scope of Communications With Payors and Physicians

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The draft guidances create a grey area between “on-label” and “off-label” communications that will require careful navigation as manufacturers develop HCEI analyses and promotional communications....more

Akerman LLP - Health Law Rx

Anti-Discrimination, Language Access Rules Compliance Deadline Fast Approaching for Health Insurers

Akerman LLP - Health Law Rx on

Health insurers and HMOs have a limited time to review the new federal meaningful access rules and amend plan documents accordingly. However, many payors still have not revised their plans to include the required language,...more

Troutman Pepper

OIG Work Plan Midyear Update Adds Activities Related to Medicare Part D and Medicaid Rebates

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The update to the Fiscal Year 2015 Annual Work Plan includes new initiatives that may affect pharmaceutical companies and Medicare Part D payors and pharmacies. Annually, the Department of Health and Human Services...more

Foley & Lardner LLP

Preparing for the Conversion to ICD-10

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With the ICD-10 implementation date delayed once again until October 1, 2015, providers who were previously unprepared for the transition or had only begun their transition planning have an extra year to address the upcoming...more

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