Health Payer/Provider Relations

Payor entities, including commercial, government (Medicare Advantage and Part D, Medicaid, Affordable Care Act), third-party administrators, medical services organizations, and pharmacy benefit managers, regularly turn to EBG Advisors for support with regulatory compliance, operations, disputes, investigations, transactions, and due diligence.

Clients benefit from EBG Advisors’ payor team of professionals with extensive compliance, operations, audit, clinical coding, data analytics, financial, and valuation experience. Our professionals also possess deep investigation consulting and forensic accounting skills. We strategize with clients and their counsel to efficiently integrate complex data management and analysis with an in-depth understanding of the highly complex world of health care transactions, reimbursement rules, regulations, compliance, and business practices.

Clients also value our extensive experience working with the leadership of several strategically important components of the Centers for Medicare & Medicaid Services (“CMS”), including the Coverage and Analysis Group, the Hospital and Ambulatory Policy Group, the Provider Enrollment Group, the Office of General Counsel, and the Health care Common Procedure Coding System Workgroup.      

Read more

We provide the following services:

• Valuation and transactions:
  • Provide fair market valuation opinions
  • Assist with transaction fraud and abuse compliance
  • Prepare pricing analysis and financial reports
• Product innovation: 
  • Work with product development
  • Evaluate new market entry strategy
  • Design a population health program
  • Conduct member segmentation studies
  • Manage pharmacy benefits
  • Review and develop behavioral health strategy
• Disputes and forensics:
  • Resolve payment disputes
  • Create risk assessment payment models
  • Conduct federal and state investigations
• Operations and systems:
  • Perform operations due diligence
  • Design and implement corrective action plans
  • Conduct risk adjustment end-to-end process reviews and clinical coding assessments
• Payor reimbursement, coverage, coding, and payment:
  • Develop payor engagement strategy
  • Advise on product commercialization
  • Address telehealth issues
  • Counsel on payor adoption and engagement
• Policy and regulatory matters:
  • Handle provider partnerships and joint ventures
  • Counsel on CMS and state regulator engagement
  • Prepare federal and state filings
  • Conduct risk analysis
• Mergers and acquisitions:
  • Provide contract valuation, and assess medical economics
  • Design care models and integration
• Medicare and Medicaid strategy:
  • Provide risk-based and value-based payment economics and structural analysis

Read less

Past Events

EBG Advisors is prepared to assist you with undertakings ranging from launching products to obtaining regulatory approval and legal representation. Please provide us with an overview of how we may be of service, or, if you have any questions, let us know and we’ll direct them to the right consultant.

Joanna Pashos
Assistant Director EBGA
EBG Advisors, Inc.
JPashos@ebgadvisors.com
T: 202.861.1822