Reimbursement Disputes

Each year, health insurers find new ways to deny payment for vital healthcare services.  It is up to every healthcare provider to develop an effective strategy for pursuing denials and claim underpayments.  

Athene Law offers effective and efficient support and solutions for provider reimbursement disputes. Our clients include healthcare entities such as hospitals and health systems, independent practice associations (IPAs), physician groups, practitioners, emergency ambulance services, and laboratories. Our primary objective is to obtain fair reimbursement from payors and to deter future payment noncompliance by payors.

Capabilities

Athene Law strategically advises its clients regarding the following issues:

• Strategies for optimizing patient registration and revenue cycle processes in order to maximize reimbursement
• Appeals of benefit denials and underpayments (including appeals directly to self-funded employer-sponsored health plans, whether or not governed by the Employment Retirement Income Security Act (ERISA))
• Pursuing Independent Dispute Resolution (IDR) under the No Surprises Act as well as under similar state law remedies (including, but not limited to, the Independent Dispute Resolution Procedure (IDRP) under California Assembly Bill (AB) 72
• Pre-litigation demands and negotiations
• Positioning disputes for litigation and arbitration