News

September 18, 2020

CMS Issues Early Release of MA Advance Notice

By Mark Spivey
The move contrasts with shorter timelines associated with the releases of the IPPS, OPPS rules. In an apparent effort to make providers’ lives a little easier, federal officials earlier this week issued Part I of the 2022 Medicare Advantage (MA) Advance Notice of proposed payment changes. “This announcement of Medicare…
Two payers allegedly inflated their bids. Earlier this month, two Independence Blue Cross (IBC) subsidiaries in Pennsylvania agreed to pay $2.25 million to resolve allegations that they defrauded the Medicare Advantage (MA) program and violated the False Claims Act by improperly inflating their bids. Medicare Advantage, also known as Medicare…
September 17, 2020

COVID and the SDoH

By Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
New study reinforces SDoH impact Focus on the social determinants of health (SDoH) continues to intensify nationwide, and that means potentially higher costs of care for healthcare organizations. The recent study by NPR, the Robert Wood Johnson Foundation, and the Harvard University T.H. Chan School of Public Health has the…
Hospital medical records are under scrutiny by the Centers for Medicare & Medicaid Services.  Via two unrelated changes, the Centers for Medicare & Medicaid Services (CMS) is targeting the hospital medical record for added scrutiny. It is clear that caring for patients during the COVID-19 pandemic costs more than during…
September 17, 2020

Do Tech Giants Violate HIPAA by Tracking Trends?

By Timothy Powell, CPA CHCP
The Social Dilemma of Health (SDoH). In March 2018, the world was shocked when it became public knowledge that Cambridge Analytica, a company based in the United Kingdom, had used data from Facebook to impact the presidential election in the United States. It turned out that they had also provided…
The Centers for Medicare & Medicaid Services (CMS) recently announced updates to the 2021 Medicare Physician Fee Schedule (MPFS). Among them are unprecedented increases in relative value units (RVUs) associated with office-based evaluation and management (E&M) visits. Under these changes, CMS will reimburse a greater number of RVUs. Then, in…
September 10, 2020

COVID-19 déjà vu

By John Foggle, MD
This has been a humbling six months to be an American and an emergency physician. It seems like we have gone from one crisis to the next, with COVID-19 persistently in the background, ready to ignite when too many people ignore it or get sloppy about prevention because of fatigue.…
September 10, 2020

Why Third Party Contracts Demand Scrutiny

By David M. Glaser, Esq.
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 provider contract is not exactly a hoot. If you combine that with the…