News

Program integrity at the Centers for Medicare & Medicaid Services (CMS) is under pressure to properly conduct Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) audits during the ongoing public health emergency (PHE). Up high on the “to be audited” list is post-payment reviews of COVID-19 claims to confirm…
As scary as it seems, COVID-19 continues to exacerbate the stark realities imposed by the social determinants of health (SDoH), racism, and health disparities. The story I’m reporting on this week is about as hard to fathom as the pandemic itself. Hospitals across the country are reporting that ICU beds…
In the world of private insurance, it’s the contract that controls. Recently, as I was speaking with one of my colleagues who specializes in reviewing and negotiating agreements with third-party payers, she lamented that no one reads their provider agreement anymore.  I fear that she may be right.  Reading a…
The social determinants of health (SDoH) have been a top news item for several years. Since the advent of the pandemic, however, they’ve been eclipsed by interwoven themes of access disparities, racial injustice, and massive public health gaps. The virus has torn through the world’s poorest communities, and ripped the…
Centers for Medicare & Medicaid Services are proposing to eliminate the inpatient-only list over the next three years. Medicare’s often-misunderstood inpatient-only list may soon be departing, as the Centers for Medicare & Medicaid Services (CMS) has proposed to eliminate it over the next three years, as outlined in the 2021…
The 340B Drug Pricing Program and the related Prime Vendor Program, or PVP, provides discounts on the purchase of outpatient drugs to certain providers. For many nonprofit and rural providers, the 340B program is a lifeline, providing drugs that are often given out to patients that can’t afford to pay…
Presidential Executive Order No. 1 was issued on Oct. 20, 1862 by President Lincoln; it established a wartime court in Louisiana. The most famous executive order was also issued by Lincoln a few years later – the Emancipation Proclamation. Executive orders are derived from the Constitution, which gives the president…
And then there were 12: Medicaid expansion, COVID-19, and the SDoH Elections in Missouri last week moved that state into the expansion fold. Voters approved creating a state constitutional amendment opening Medicaid eligibility to healthy adults, as of July 2021. This win was a big one, given strong opposition from…