Carrie Douglas is a healthcare reimbursement and dispute resolution practitioner who represents hospital systems, ambulatory surgery centers and large physician practices in reimbursement disputes involving commercial payors and third-party administrators. She is known for helping healthcare providers maximize reimbursement recoveries through both litigation and pre-litigation strategies.
Carrie advises clients on a broad range of reimbursement-related matters, including disputes governed by managed care contracts as well as non-contracted payor-provider disputes. She has extensive experience addressing issues related to unilateral payor policies, including COVID-19 reimbursement, reference-based pricing, out-of-network plans, line-item denials and E/M downcoding.
Her practice also includes disputes involving experimental and investigational designations, medical necessity challenges, plan exclusions, diagnosis-related group (DRG) downgrades and refunds, overpayment notices, offsets and reimbursement adjustments. Through these efforts, she has achieved numerous successful pre-litigation resolutions on behalf of healthcare providers.
In addition, Carrie has developed successful programs to pursue reimbursements through the No Surprises Act CMS portal and Texas Independent Dispute Resolution (IDR) portals. She also advises hospitals and healthcare systems on compliance with the Hospital Price Transparency Rule.
- Dispute resolution
- Healthcare
- Pharmaceutical and life sciences
- JD, The University of Texas School of Law - 2004
- BBA, and BA, The University of Texas at Austin - 2001
- Texas