Articles and Blogs

With employee health plan costs continuing to rise at an alarming rate, medium-sized employers are increasingly rejecting traditional insurance models built around a network of preferred providers and turning to a non-network model wherein the plan appoints a pricing consultant as a “Designated Decision Maker” (“DDM”) with discretionary and ultimate decision-making authority for determining... READ MORE

On June 26, the Supreme Court granted certiorari to review the current administration’s executive orders barring people from certain countries from entering the United States. The Court granted a stay of the executive orders in part but will allow some people to be stopped at the border under the executive orders while the case... READ MORE

In case you missed it, on June 16, the American Health Law Association released a comprehensive member briefing entitled “The OIG’s Resource Guide: An Important New Tool for Measuring Compliance Program Effectiveness”[1] (Compliance Program Briefing). The Compliance Program Briefing was authored by four Hall Render attorneys. A copy of the Compliance Program Briefing can... READ MORE

Health system supply chain departments (and increasingly more C-suite leaders) appreciate the potential savings that standardization and centralization can generate for their organization given that 30 to 50 percent of their budget is associated with supply chain costs. However, implementing strategies and procedures, or even knowing where to start in order to generate these savings,... READ MORE

CDC’s opioid prescribing guidelines prompt states to adopt quantity limits Indiana Governor Eric Holcomb recently signed into law Senate Enrolled Act 226 (SEA 226), which places limits on the opioid quantities that may be prescribed by state-licensed practitioners beginning July 1, 2017. Prescribing caps on opioids have gained increasing popularity following the March 2016... READ MORE

On May 17, Sen. James Lankford (R-OK) introduced companion legislation (S. 1133) to the House bill that would repeal the Affordable Care Act’s (“ACA”) moratorium on physician-owned hospitals. Named the Patient Access to Higher Quality Health Care Act of 2017, the bill is the Senate’s version of legislation (H.R. 1156) previously introduced in the... READ MORE

Physician groups composed of MIPS eligible clinicians (“MECs”[1]) may elect to have their members’ MIPS performance scored individually or as a group. This article notes a few key aspects of MIPS group scoring for 2017. MIPS Group Scoring Includes Performance Data from New Medicare-Enrolled MECs For the 2017 MIPS performance period, a new Medicare-enrolled... READ MORE

While many providers recognize there are benefits to integrating behavioral health and primary care, reimbursement for services continue to be one of the most challenging barriers to achieving integration. The Mental Health Parity and Addiction Equity Act of 2008 and the 21st Century Cures Act signed into law in December 2016 are efforts made... READ MORE

On May 25, 2017, the Michigan Supreme Court dealt another blow to medical providers seeking payment for services provided to individuals injured in car accidents in Michigan. In the opinion, the court held that a medical provider does not have standing to bring a claim against a no-fault insurer for the payment of personal... READ MORE

The Supreme Court of the United States (“SCOTUS”) ruled on Monday, June 5, 2017 that retirement plans maintained by religiously affiliated hospitals meet the definition of a church plan under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”). As church plans, they are not subject to ERISA’s rules and regulations unless... READ MORE