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McBrayer Blogs
Showing 57 posts in Medicaid.
New Rule Brings Sweeping Changes to Physician Privacy, Part II
Earlier this week, we discussed the new U.S. Department of Health and Human Services (HHS) policy on disclosure of Medicare reimbursement to individual physicians. The policy, set to take effect on March 18, 2014, enables the Centers for Medicare & Medicaid Services (CMS) to evaluate requests for physician pay information under the Freedom of Information Act (FOIA) and, in some cases, release the data. This new policy marks a fundamental shift in HHS’ commitment to protect physician privacy. More >
Medicare Physician Fee Schedule Final Rule Issued for CY 2014
The CY 2014 Medicare Physician Fee Schedule (“PFS”) final rule has been issued. The rule, over 1,000 pages in length, determines physician reimbursement for services provided to Medicare beneficiaries. Let’s take a look at just a few of the changes contained therein. More >
Top Ten Health Law Issues for Physicians, Health Systems and Providers in 2014
Change is the one constant that physicians, health systems and other providers face in 2014 as the ACA and its myriad regulations become effective along with increasing review and scrutiny from not just state and federal regulators, but also private companies with state and federal contracts to review and audit claims, cost reports, and billing practices. So, listed below are the top ten areas that physicians and other providers should watch in 2014. More >
An Unlikely Consequence, cont.
On Tuesday, I discussed the recent trend of hospital layoffs of staff, administrative and professional alike, in order to reduce costs despite expectations of an unprecedented number of individuals seeking health care services under the ACA. More >
Kentucky Selected To Participate in ER “Superusers” Program
If you have ever visited an emergency room in the Commonwealth, chances are that you have seen a “superuser” – a person who uses the emergency room for regular health care instead of opting for a lower-cost alternative such as a primary care physician. Whether Medicaid recipients or uninsured, superusers (also known as “super-utilizers” or “frequent flyers”) increase Medicaid expenditures and drive up the overall costs of health care. In 2012, 4,400 Medicaid recipients used an emergency room ten or more times, and Kentucky Medicaid spent more than $219 million on emergency room use. Superusers, however, do not just waste money. They also waste the valuable time and resources of emergency room providers, creating longer wait times for those experiencing true emergencies. More >
The Pioneer Program Report Card
In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization (“ACO”) program created through the Affordable Care Act (“ACA”). The program’s goals were to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity. More >
Medicaid Expansion in Kentucky
The Supreme Court upheld much of President Obama’s Patient Protection and Affordable Care Act (“PPACA”) in National Federation of Independent Business et al v. Sebelius, but overturned a key element of PPACA’s Medicaid expansion provisions. Originally, PPACA required states to expand Medicaid coverage to individuals at or below 133 percent of the federal poverty level or risk forfeiting existing federal funding for the state’s Medicaid program. In National Federation, the Supreme Court held that PPACA could not withdraw existing Medicaid funding from states choosing not to expand their programs. This change presents each state with a meaningful choice to opt in or out of PPACA’s Medicaid expansion. More >
Senate Finance Committee Takes an In-Depth Look at Fraud & Abuse
Earlier this week, I discussed the HHS and DOJ Annual Report for the Health Care Fraud and Abuse Program. HHS and DOJ are not the only ones who are determined to purge the health care industry of its woes. On January 31, 2013 a group of six current and former members of the Senate Finance Committee released a comprehensive report detailing recommendations on combating waste, fraud and abuse in the Medicare and Medicaid Programs. More >
Annual Report Details Record Breaking Success in Health Care Fraud Prevention
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), required the establishment of a national Health Care Fraud and Abuse Control Program (“HCFAC”). The HCFAC Program is a joint Department of Justice (“DOJ”) and Health and Human Services (“HHS”) coordination of federal, state and local law enforcement activities to combat fraud committed against all health plans, both public and private. More >
CMS 2014 Call Letter: A Bright Future for CMS Star Rating System
On February 15, the Centers for Medicare & Medicaid Services (CMS) issued the draft calendar year (CY) 2014 Call Letter for the Medicare Advantage (MA) and Part D programs (Call Letter). It contains information that MA organizations and Part D plan sponsors (collectively, Plan Sponsors) need to prepare their 2014 bids and operations. More >
