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Webinar Participant Information

Strategies for Challenging Health Plan Policies, Guidelines, and Practices That Impact Coverage and Reimbursement Webinar

Originally recorded June 19, 2019.




A technique we have seen payers use more commonly in recent months than in the past is to unilaterally implement policies and guidelines through provider manuals that arguably change the coverage, steerage, and/or reimbursement of key healthcare services for their members. These policy changes oftentimes have material effects on the amounts hospitals actually receive under their contracts.  Providers seldom have any input into these revisions, and they are frequently imposed on providers with little or no notice. What can you do to adapt quickly or challenge these policies to minimize the impact on your organization?

This webinar will help you understand your rights under your contract and the role you need to play when contesting these policies.

Recommended for:

Chief financial officers, chief operating officers, reimbursement directors, patient financial services directors, revenue cycle directors, controllers, managed care directors, compliance officers, in-house legal counsel, and financial consultants.


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John Barnes
King & Spalding

Mr. Barnes specializes in managed healthcare arrangements. As a partner in our Healthcare practice, he advises clients on the structuring of risk-based managed care contracts (including capitation and shared savings arrangements), as well as traditional fee-for-service arrangements. He also advises clients on contract terminations, network access disputes, and revenue cycle practices.

Stephen Goff
King & Spalding

Steve Goff focuses on healthcare litigation. As a partner in our Healthcare practice, Steve represents healthcare providers in a variety of high-profile matters. Mr. Goff defends healthcare providers in high-stakes litigation and arbitration. In addition, he often works with providers to develop contracting and operational strategies, align these strategies with revenue-cycle improvements, and mitigate risks. He also has substantial experience with all aspects of managed healthcare, particularly under the delegated model.

Amber Kemp
Vice President, Health Care Coverage
California Hospital Association

Amber Kemp provides advocacy and support regarding government-funded programs and other health care coverage policy issues affecting California hospitals and health systems. She also leads the CHA Community Benefit Committee, Managed Care Committee, and Payer Relations Committee. Ms. Kemp represents CHA members on various state-level advisory groups and committees and is a frequent speaker on California’s implementation of the Affordable Care Act