Articles and Blogs

NATIONAL EHR interoperability, connectivity a big challenge around globe new study finds AHA Asks CMS to Delay New Bundled Payment Model Anthem amends ER policy but stands behind decision not to pay for avoidable emergency care Albertsons, Rite Aid deal creates U.S. supermarket and health care giant Health experts suggest signing bank loans at... READ MORE

In February of 2017, the U.S. District Court for the Eastern District of Texas ordered a Texas hospital (the “Hospital”) “to immediately submit to the National Practitioners Data Bank a Void Report” regarding a physician whose clinical privileges were restricted by the Hospital’s medical executive committee, resulting in a report to the National Practitioner Data... READ MORE

NATION All 71 new 2017 ASCs by specialty Follow the money: Inpatient surgery moving out of hospitals into ambulatory centers Study: Only one-quarter of clinicians comfortable with value-based payment program Amazon eyes another healthcare shake-up: Getting into supply chain AHA recommends CMS delay application deadline for BPCI Advanced Gottlieb Outlines FY 2019 Budget Goals... READ MORE

NATIONAL Medical bills rise after hospitals acquire physician practices, studies suggest Dialysis provider Fresenius hit with $3.5 million HIPAA fine DOJ Memo Brings Promising News for Providers Facing Government Action Medicare pay cut dropped from spending bill passed by House Former CMS Administrator Andy Slavitt to create ‘United States of Care’ Coalition of 44... READ MORE

On October 1, 2017, the Centers for Medicare & Medicaid Services (“CMS”) implemented its national targeted probe and educate (“TPE”) program. TPE is designed to reduce improper payments by identifying providers/suppliers with high denial rates or unusual billing practices and providing education to correct non-compliance with claim submission criteria. However, repeated errors could potentially... READ MORE

NATIONAL Apple wants to gather all your medical records in the Health app 10 predictions for healthcare industry growth in 2018 Kaufman Hall: Hospital M&A jumped 13% from 2016 U.S. telehealth industry eyes Medicare for its next big check What To Watch In Health Care In 2018: Six Key Trends ‘Not a lot of... READ MORE

Due to an expiration of certain provisions in the Social Security Act, there are several changes to the Medicare therapy caps effective for dates of service on or after January 1, 2018. Hospitals and other therapy providers should review these changes to determine their impact on current operations. Therapy providers should also monitor legislation... READ MORE

Recently, the D.C. Court of Appeals held that CMS Manual instructions are general statements of policy, which have no binding effect. Although this case involved a procedural claim, the court’s decision reminds providers that solely relying on CMS Manual instructions as guidance for Medicare coverage criteria could result in potential Medicare payment compliance issues.... READ MORE

In its recent MLN Connects for January 25, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a reminder to providers regarding appropriate change in ownership reporting. Notification Requirements All physicians, non-physician practitioners, physician practitioner organizations and non-physician practitioner organizations are required to report any changes in ownership, as well as changes in... READ MORE

NATIONAL Six things to know about CMS’ new bundled payment model The big bang is coming in health care, and it will spark the next industrial revolution Medical industry trends toward more openness after errors Hospitals’ best-laid plans upended by disaster CMS to form interagency group to review Stark Law: 4 things to know... READ MORE