Healthcare
Thaler IP Law advises healthcare providers and organizations on select federal regulatory, reimbursement, and out-of-court healthcare matters. Our work is concentrated in the federal No Surprises Act, independent dispute resolution, HIPAA, and EMTALA. For matters involving state-specific law, the firm's ability to assist depends on the jurisdiction and the nature of the matter.
Independent Dispute Resolution
The federal No Surprises Act created an independent dispute resolution process for out-of-network payment disputes between providers and insurers. IDR is a federal process, and we advise hospitals, physician groups, and billing departments on eligibility, dispute initiation, submission preparation, and responding to insurer arguments.
For practices and facilities managing high claim volumes, we advise on batching strategy and submission approach to support a well-built IDR record.
What We Handle
- IDR eligibility assessment and dispute initiation
- Submission preparation and supporting documentation
- Qualifying payment amount analysis and benchmarking
- Response to insurer IDR submissions
- Batching strategy for high-volume claim portfolios
- Post-determination payment follow-up
- No Surprises Act compliance obligations for providers and facilities
IDR has strict timelines and submission requirements. Hospitals, physician groups, and billing administrators come to us when they want to understand the process and build a well-supported submission from the start.
Compliance
Federal healthcare compliance requirements change regularly, and gaps create real exposure. We advise hospitals, physician groups, and billing administrators on federal compliance obligations, including HIPAA, the No Surprises Act, and federal billing requirements.
For state-specific compliance matters, the firm's ability to assist depends on the jurisdiction and the nature of the issue.
What We Handle
- HIPAA compliance program review and policy drafting
- Federal billing compliance assessments
- No Surprises Act compliance obligations for providers and facilities
- Good Faith Estimate preparation for uninsured and self-pay patients
- Compliance documentation and policy support
- Response to federal government inquiries and audits
- Compliance program guidance for emerging practices
Compliance gaps rarely appear at convenient times. We help clients understand their federal obligations before an inquiry forces the issue.
Insurance Disputes
Claim denials and underpayments are a recurring challenge for healthcare providers. We advise providers and facilities on the appeals process, payer contract issues, and the documentation needed to support a dispute — whether the matter falls within the federal IDR process or requires a different avenue.
The availability of specific remedies, including state insurance department complaints and state-law payer contract disputes, depends on the jurisdiction and the nature of the matter.
What We Handle
- Claim denial review and appeal strategy
- Downcoding and underpayment disputes
- Payer contract review and negotiation support
- Internal and external appeal preparation
- Dispute documentation and record preparation
- Coordination of benefits disputes
- Guidance on available federal and state remedies
A denied claim is not always a final answer. We help providers understand the options available and what it takes to build a well-supported dispute.
Emergency Medicine
Emergency medicine providers face a distinct set of legal and regulatory challenges. They treat patients without the ability to pre-screen coverage, operate under strict federal EMTALA obligations, and are disproportionately affected by the payment disruptions the No Surprises Act was designed to address.
We understand how emergency departments and emergency medicine groups operate, and we advise on the legal issues that arise from that environment: reimbursement disputes, IDR filings, EMTALA compliance, and the operational policies that govern how facilities handle patients, billing, and payer relationships.
What We Handle
- Emergency medicine IDR strategy and submissions
- EMTALA compliance and policy review
- Out-of-network payment disputes with commercial insurers
- Emergency department billing compliance
- Payer contracting disputes for emergency medicine groups
- On-call and coverage agreement review
- Risk management policy support for ED operations
Emergency providers cannot turn patients away. We help them understand their rights and navigate the federal processes available to address underpayment for the care they are required to provide.
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