The American Arbitration Association has adopted a new set of rules to govern commercial disputes between hospitals, physicians and insurers. Alan Lash, JD, is a founding partner with Lash & Goldberg, a boutique litigation firm with offices in Miami and Fort Lauderdale, and also serves on the AAA's national Health Care Alternative Dispute Resolution Advisory Council. He helped develop the new rules earlier this year in an effort to reduce the cost and time typically spent in traditional litigation of payor-provider disputes.
The revised rules provide guidance for administrative procedures, streamlined discovery, grouping claims and document exchange. Arbitration is often faster than litigation in court — a characteristic that has traditionally been considered an advantage to this type of alternative dispute resolution. Still, payor-provider disputes can grow quite complex. Mr. Lash has seen these arbitrations take as little as six months or as long as three years. "Hopefully, these rules will reduce expensive and time-consuming battles involving the discovery of information," he says.
One of the most time-consuming, and thus expensive, processes in arbitration is the discovery of documents. This can become a back-and-forth game between the two parties — something arbitration is meant to avoid. "One of the new rules requires an early upfront exchange of documents and information you'd need in a payor-provider dispute," says Mr. Lash. This might be a bill, an explanation of benefits or medical records. By exchanging these items right away, both parties can avoid a delayed process that might lead to uncertainty or gamesmanship.
Overall, Mr. Lash thinks there might be a reduction in payor-provider disputes as the ACO model comes into play and health insurers, hospitals and physicians develop closer relationships. There is also a large amount of litigation between payors and providers that do not have contracts, which results in a large amount of uncertainty over how much payors should reimburse providers. "These rules are available to those parties if they choose arbitration as well, even if they don't have contracts," says Mr. Lash.
To help payors and providers resolve these disputes in a more efficient manner, the AAA is also developing a panel of arbitrators with experience in payor-provider disputes specifically. "So not only will there be unique rules, but hopefully arbitrators with extensive experience," says Mr. Lash.
Read the new rules for payor-provider arbitration in full.
Learn more about Lash & Goldberg.
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The revised rules provide guidance for administrative procedures, streamlined discovery, grouping claims and document exchange. Arbitration is often faster than litigation in court — a characteristic that has traditionally been considered an advantage to this type of alternative dispute resolution. Still, payor-provider disputes can grow quite complex. Mr. Lash has seen these arbitrations take as little as six months or as long as three years. "Hopefully, these rules will reduce expensive and time-consuming battles involving the discovery of information," he says.
One of the most time-consuming, and thus expensive, processes in arbitration is the discovery of documents. This can become a back-and-forth game between the two parties — something arbitration is meant to avoid. "One of the new rules requires an early upfront exchange of documents and information you'd need in a payor-provider dispute," says Mr. Lash. This might be a bill, an explanation of benefits or medical records. By exchanging these items right away, both parties can avoid a delayed process that might lead to uncertainty or gamesmanship.
Overall, Mr. Lash thinks there might be a reduction in payor-provider disputes as the ACO model comes into play and health insurers, hospitals and physicians develop closer relationships. There is also a large amount of litigation between payors and providers that do not have contracts, which results in a large amount of uncertainty over how much payors should reimburse providers. "These rules are available to those parties if they choose arbitration as well, even if they don't have contracts," says Mr. Lash.
To help payors and providers resolve these disputes in a more efficient manner, the AAA is also developing a panel of arbitrators with experience in payor-provider disputes specifically. "So not only will there be unique rules, but hopefully arbitrators with extensive experience," says Mr. Lash.
Read the new rules for payor-provider arbitration in full.
Learn more about Lash & Goldberg.
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