Articles and Blogs

To be paid by Medicare, Organ Procurement Organizations (OPOs) and transplant centers must be members of the United Network for Organ Sharing (UNOS), which manages the Organ Procurement and Transplantation Network (OPTN). Transplant centers and OPOs must comply with multiple oversight agencies and requirements, including OPTN policies and guidelines and the Medicare Conditions of... READ MORE

NATIONAL Verma puts Medicaid insurers on notice, says CMS will begin ‘targeted audits’ While surgery centers support CMS payment proposal, hospital groups submit harsh criticism Supreme Court to hear DSH payments case Banner Health, Ascension executives join hundreds of hospital CEOs defending 340B program MGMA shares physician practice keys to success MGMA18: Underwhelming MIPS... READ MORE

On September 17, 2018, the U.S. Department of Justice (“DOJ”) approved the $52 billion vertical merger between health insurer Cigna Corp. (“Cigna”) and pharmacy benefit manager (“PBM”) Express Scripts. The Cigna-Express Scripts merger is just one in a string of recent health insurer/PBM acquisitions. For more on these transactions, click here. As the largest unaffiliated... READ MORE

NATIONAL How providers can innovate to combat physician burnout CMS: Innovative new payment models are coming—and some will be mandatory Lack of consistent process hinders data sharing among HHS agencies, report finds Apple Watch Should Pave Way for More Medical Gadgets, FDA Says Pharma lobby mounts last-ditch effort to fix prescription ‘doughnut hole’ Less... READ MORE

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“Proposed Rule”). Among many other changes, CMS proposed numerous modifications to the required documentation for evaluation and management (“E/M”) visits in order to alleviate the administrative burden on practitioners and... READ MORE

Hospitals in Illinois received good news last week when, after years of litigation in state court, the Illinois Supreme Court in Oswald v. Hamer[i] upheld the constitutionality of Section 15-86 of the Illinois Property Tax Code, which addresses tax exemptions for hospitals. While this decision allays recent uncertainty surrounding hospital property tax exemptions and... READ MORE

NATIONAL How ASC facilities turn their smaller operations into safer operations Private equity pushes into healthcare Walmart wants to bring its ‘everyday low prices’ to health care Only 18% of physicians say value-based payments will improve care, survey finds Half Of U.S. Doctors Have Pay Tied To ‘Value-Based Metrics’ HHS launches ASC safety database... READ MORE

On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE

In the era of value-based care, health care providers and manufacturers are increasingly examining risk sharing opportunities in the treatment of patients. On September 17, the Department of Health and Human Services Office of Inspector General (“OIG”) published Advisory Opinion 18-10 whereby it approved a proposed risk sharing initiative with defined guardrails. Advisory Opinion... READ MORE

As Hurricane Florence inaugurates the U.S. hurricane season with fierce winds and torrential rains, health care providers are preparing to care for patients under demanding and dangerous conditions. Effective communication is always challenging and critically important when natural disasters like hurricanes strike. The Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule (the “Privacy... READ MORE