Advanced Alternative Payment Models For 2018 Revealed By CMS
The Centers for Medicare & Medicaid Services (CMS) recently announced new arrangements for payments that will be qualified as Advanced Alternative Payment Models (APMs) under the Quality Payment Program (QPP) that is planned to start in the 2018 performance year. Those physicians and eligible clinicians who get some percent of revenue from the Advanced APMs…
The Failure Of CO-OP Program Raises Concerns For CMS
A recent report released by the House Energy and Commerce Committee stresses on the failures of Consumer Operated and Oriented Plan (CO-OP) program from CMS. The non-profit startup insurers, CO-OPs were introduced by the CMS in order to compete with established insurance companies in insurance exchanges. This program was authorized under the Affordable Care Act,…
The Senate Passes Comprehensive Addiction And Recovery Act (CARA) Of 2016
After the result of a recent voting, the Senate decided to pass the S. 524 Bill, the Comprehensive Addiction and Recovery Act (CARA). The approved bill was passed on to the President of United States, Barrack Obama, who later signed the bill in to the law. CARA is mainly focused on reducing the opium abuse…
Supreme Court Ruling Clarifies Scope Of False Claims Act Liability
The US Supreme Court recently issued an undisputed decision on the Universal Health Services v. Escobar case that has great implications for upcoming False Claim Act (FCA) cases. The Court also ruled that the same theory for FCA liability could be implemented for proving the non-compliance of an institution. Besides that, an exceptional materiality standard…
HHS Being Held Responsible For Off-Label Marketing Guidelines Delay
The Department of Health and Human Services (HHS) was recently accused by two House Republicans for the holding up of off-label marketing guidelines by FDA. The lawmakers sent a letter to the HHS Secretary, Sylvia Burwell, stating that they are “perplexed” on the matter, as FDA has neither presented any strategy on off-label marketing, nor…
Congress To Pushback Plan B Drug Payment Proposal
A new proposed rule issued in March 2016, aimed at creating a new Medicare payment methodology for part B drugs administered by physicians and other providers, is taking a lot of heat from both parties of the Congress. Both Republican members of the House of Representatives and the Democratic Senators on the Senate finance committee…
New HIPAA Audit Protocol And Other Audit-Related Materials Let Out By OCR
At the beginning of the month, the Department of Health and Human Services Office for Civil Rights (OCR) let out a redone audit protocol, which addresses the requirements of the 2013 Omnibus Final Rule. OCR will use the audit protocol to commence its approaching phase 2 audits, which will be performed for covered entities and…
CMS’s Final Ruling On Medicare Advantage Payment Rate Appreciated By AHIP
CMS has made its final ruling on the Medicare Advantage Payment Rate and it has been appreciated by AHIP. According to the reports published by CMS, the Final Medicare Advantage payment rates proposed for the coming year are lower as compared to the same proposed by the government last February. CMS also revealed a lot…
District Court Of Appeals Judges In Favor Of Healthcare Provider
December 2015 saw the judgment on a crucial case in the healthcare industry. The case was between a prominent insurance service and a healthcare provider, about the assignment of an out-of-network health insurance payment to the healthcare practitioner. The Third Circuit Court of Appeals, under whose jurisdiction both the insurance service and healthcare provider come,…
