Billing and Reimbursement Guidance

Healthcare is one of the most heavily-regulated industries, and understanding evolving rules and regulations that govern billing and reimbursement can be a daunting task for providers and practitioners. Athene Law brings deep expertise not only in the complex legal framework, but also in the industry standards that shape operational and strategic decisions. 

We help clients navigate the risks and opportunities inherent in billing practices, offering practical guidance so they can make informed, compliant, and forward-thinking choices. Our team also supports clients in negotiating reimbursement terms with payers, helping ensure that business objectives align with legal requirements and regulatory expectations.

In addition to prospective operational guidance, we assist clients in addressing retrospective issues—including payer audits, overpayment investigations, and implementing corrective actions—to mitigate risk and protect the integrity of their billing operations.

Capabilities

Clients across the healthcare industry— including physicians and group practices, healthcare facilities, hospitals, health systems, and both for-profit and non-profit organizations—rely on Athene Law for strategic guidance and skilled representation in navigating today’s complex regulatory landscape.

Our attorneys’ diverse experience within the healthcare industry has prepared the team to represent practices and professionals in a highly-regulated environment. 

Our billing and reimbursement advisory services include:

• Value-based reimbursement
• Clinical integration and alignment models
• Risk-based payment structures
• Alternative payment methodologies, including pay-for-performance, shared savings, bundled payments, and capitation
• Compliance with financial assistance policies
• Balanced billing guidance and compliance
• Managed care and provider network contracting
• Payer reimbursement disputes
• Dispute resolution and arbitration
• Medicare, Medicaid, and Medi-Cal program billing and reimbursement
• Out-of-network billing and reimbursement challenges