Medicaid and Medicare Managed Care

Governmental managed care, including Medicare Advantage and Medicaid managed care, is quickly expanding to eclipse fee-for-service programs.  Athene Law, LLP combines its deep regulatory expertise from the Medicare and Medicaid (Medi-Cal in California) programs with its commercial managed care experience to support clients address complex issues involving governmental managed care, including managed care contracting and disputes.

Capabilities

Clients in the healthcare industry, including physicians and groups, facilities, for-profit and non-profit entities, hospitals, and hospital systems need guidance and representation for a variety of needs.

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

Medicaid and Medicare managed care capabilities include:

• Preparation and negotiation of governmental managed care agreements
• Development and revision of alternative payment models, including bundled payments and risk delegation agreements
• Dispute resolution, arbitration, and litigation
• Escalating Medicare Part D disputes, particularly through the complex administrative appeal process
• Regulatory guidance for governmental managed care programs, including billing issues, overpayment analyses and copay waiver/financial assistance guidance 
• Transitioning to out-of-network status
• Provider-plan integration strategies
• Provider incentive program development