Mackenzie Wallace Co-Authors ABA Book on Managed Care Reimbursement

Thompson Coburn partner Mackenzie Wallace co-authored the new American Bar Association publication A Practical Guide to Reimbursement in Managed Care, which provides a detailed account of Medicare reimbursement and payment approaches used across provider types. The book also includes a practical discussion of commercial payer contracting and payment strategies. It concludes with an analysis of the legal issues that arrive in payer-provider disputes, including the most common issues and case examples. The publication’s co-authors include Joanna Younts, Steven Hamilton, and Franklin Stevens.

“One of the goals of managed care is to improve the quality of and access to care for patients, but the intricacies of the processes related to the delivery and reimbursement of healthcare services can result in complex administrative procedures for providers,” the authors concluded in the guide. “In turn, these complexities can trigger underpayments and claim denials that can impact providers’ ability to provide access to high-quality patient care. Ensuring fair and accurate reimbursement to providers is important to ensure that quality and access are not undermined.”

Mackenzie is an experienced trial attorney representing health care entities, businesses, and directors in high-stakes litigation. She represents hospitals and health care providers in coverage and reimbursement disputes; fraud and civil RICO claims; Texas Prompt Pay Act, qui tam, and False Claims Act litigation; and matters relating to the violation of federal and state anti-kickback provisions and Stark laws.

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