PAYOR CONTRACTING AND AUDITS
Enhanced Contract Rate Negotiation, Alternative Payment Models, Managed Care Contracts, Medicare Advantage Risk Adjustment, RAC, MAC and ZPIC Audits
Wade, Goldstein assists practices in developing relationships and negotiating contracts with government and private payors. The Wade, Goldstein attorneys guide those practices toward success within the current managed care environment. This includes the development and operation of managed care organizations, clinically integrated networks, accountable care organizations and other emerging practice forms that give practices leverage in negotiating with the nation’s largest payors. The Wade, Goldstein attorneys have experience in assisting practices in contracting with payors for enhanced rates, carve outs, and additional covered services. They are experienced in reviewing payor contracts and will work on clients’ behalf to ensure that they received the best contract possible.
The Wade, Goldstein attorneys also assist practices in responding to the variety of payor audits that are plaguing the health care industry. They have experience in defending RAC audits, ZPIC audits, Medicare Advantage risk adjustment audits and private-payor audits. Through these experiences, the Wade, Goldstein attorneys have developed contacts with high-level authorities within the leading payor organizations, including the Centers for Medicare and Medicaid Services (CMS).