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Showing 57 posts in Medicaid.

CMS Proposes to Change Physician Requirements for RHC's and FQHC's

February 22, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), Federally Qualified Health Centers (“FQHCs”), Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”), Rural Health Centers (“RHCs”)

Since the passage of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), many providers, suppliers and physicians that were enrolled in Medicare and Medicaid were mandated to create compliance programs for their healthcare facilities. Since that time, small and rural providers have been scrambling to adopt and implement programs that can adequately withstand regulatory and law enforcement scrutiny. Larger providers, such as multi-state hospitals, were already equipped with a compliance program. It is the small and rural providers, limited by staff and financial resources, which have had their hands full complying with the new regulatory requirements. More >

Tags: Health Care Law

The Wrap-Around Slap-Around for Primary Care Centers

January 17, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), Federally Qualified Health Centers (“FQHCs”), Health Care Law, Kentucky Primary Care Centers (“PCCs”), Managed Care Organizations (“MCOs”), Medicaid, Rural Health Centers (“RHCs”)

For Kentucky Primary Care Centers (“PCCs”), Rural Health Centers (“RHCs”), and Federally Qualified Health Centers (“FQHCs”), getting the run-around from Medicaid on wrap-around payments is not so unusual.  Frequently, these providers complain that supplemental payments distributed by the Kentucky Department for Medicaid Services’ (“Medicaid”) are too low, too late or both. More >

Tags: Health Care Law

Reforming Medicare Audits

November 8, 2012
Posted In Health Care Law, Medicaid, Medicare, Medicare Audit Improvement Act of 2012, Recovery Audit Contractors (“RAC”)

On October 16, 2012, the Medicare Audit Improvement Act of 2012[1] was introduced in the U.S. House of Representatives by Representative Sam Graves. The purpose of this legislation is to reform the Medicare auditing program. This legislation aims to improve the accuracy and transparency of Medicare audits of hospitals as well as increase the accountability of Recovery Audit Contractors (“RAC”).[2] More >

Tags: Health Care Law

Changes to Deadlines for Stage Two – Meaningful Use in the Medicare and Medicaid EHR Incentive Programs

October 25, 2012
Posted In Critical Access Hospitals (“CAHs”), Electronic Health Records (“EHR"), Health Care Law, Health Information Technology for Economic and Clinical Health Act (HITECH Act), Medicaid, Medicare

Under the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, health care professionals and hospitals may qualify for incentive payments when they adopt and meaningfully use certified electronic health records (“EHR") under a three stage process. More >

Tags: Health Care Law

Guess Who’s Coming to Visit? Long-Term Care Facility Inspections

September 4, 2012
Posted In Health Care Law, Medicaid, Medicare, Occupational Safety and Health Administration (“OSHA”), Office of Inspector General of the United States Department of Health and Human Services (OIG), Patient Protection and Affordable Care Act (“ACA”)

Compliance and preparedness are two very real, everyday concerns for long-term care facilities. Not only are these important aspects of daily operations for the safety of the employees and patients, they are paramount because any day a visitor from the Office of the Inspector General (OIG”) or Occupational Safety and Health Administration (“OSHA”) could show up for an inspection.  Is your facility prepared? More >

Tags: Health Care Law

Compliance Plan – A Provider’s Defense

August 27, 2012
Posted In Abuse and Waste, Affordable Care Act, Department of Health and Human Services (HHS), Health Care Fraud, Health Care Fraud and Abuse Control Program, Health Care Law, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG), Patient Protection and Affordable Care Act (“ACA”)

The Office of the Inspector General (“OIG”) has always encouraged Medicare and Medicaid providers to implement a compliance program. For 14 years, as a matter of fact, OIG has provided compliance guidance in 11 healthcare sectors (including: hospitals, nursing facilities, home healthcare, hospice and third-party billers). With the passing of the Patient Protection and Affordable Care Act (“PPACA”), compliance plans and programs are now mandatory for any provider enrolled in a Federal health care program, including Medicare. More >

Tags: Health Care Law

Fraud, Waste and Abuse Controls Under The Affordable Care Act

August 20, 2012
Posted In Abuse and Waste, Affordable Care Act, Department of Health and Human Services (HHS), Health Care Fraud, Health Care Fraud and Abuse Control Program, Health Care Law, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

The Affordable Care Act (“ACA”) strives to improve our health care system in three main areas; by expanding consumer protections, strengthening Medicare and reducing health care costs.  One key way the government hopes to achieve these goals is through tougher fraud and waste controls. Given the focus on prevention, penalty and recovery, compliance plans are of the utmost importance for all health care providers. First we examine all of the elements incorporated in the ACA that pertain to fraud, abuse and waste before we can begin to develop a compliance plan for our facilities. The new law contains a host of tools aimed at enforcing fraud and waste prevention.  Let’s review: More >

Tags: Health Care Law

Accountable Care Organizations Program Models

August 13, 2012
Posted In Accountable Care Organizations (“ACO”), Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare

The Supreme Court’s decision upholding the Affordable Care Act supports The Centers for Medicare and Medicaid Services (CMS) different programs for the development of Accountable Care Organizations (ACOs).  In Kentucky, we are beginning to see these organizations emerge in different models. More >

Tags: Health Care Law

Supreme Court Decision Legitimizes Accountable Care Organizations

August 9, 2012
Posted In Accountable Care Organizations (“ACO”), Affordable Care Act, Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

With its decision upholding the Affordable Care Act, the Supreme Court has authorized the use of Accountable Care Organizations (“ACO”) as one of the principal tools for addressing health care costs and improving care.  When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely by reducing the rate of growth in the cost of health care, the ACO will share in the savings it achieves for the Medicare program.  The Centers for Medicare and Medicaid Services (“CMS”) announced the selection of 88 ACOs to participate in the first round of the Medicare Shared Savings Program. These ACOs will take responsibility for coordinating care for nearly 1.2 million Medicare beneficiaries in 40 states. Three ACOs have been approved for Kentucky and include Quality Independent Physicians (Louisville), Southern Kentucky Health Care Alliance (Smithsgrove), and Deaconess Care Integration (Serving Indiana and Kentucky). In late July, CMS announced 15 new ACOs to participate in the Advance Payment ACO Model Program including Jackson Purchase Medical Association PSC, which is an ACO that includes 6 physician practices in Paducah and Ballard County Kentucky that covers 6000 Medicare beneficiaries. This brings the total participation in the program to 20.   With the 32 systems approved to participate in the Pioneer ACOs Program in February 2012, CMS announced there are now 153 organizations participating in Medicare Shared Savings initiatives, serving over 2.4 million beneficiaries. More >

Tags: Health Care Law

Federal Medicaid Opt-Out Effect on Hospitals

August 2, 2012
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

The mandatory expansion of Medicaid was an important element of the Affordable Care Act as providing health care benefits to uninsured was intended to achieve equity.  The expansion of Medicaid rolls was also intended to reduce the cost of providing care for the uninsured and the need for disproportionate share hospital funding, which is an adjustment to account for the needs of hospitals serving a large number of low-income patients.  With the ability to opt out of the Affordable Care Act’s expansion of Medicaid eligibility (read more: The Federal Medicaid Apple:  Poison or the Cure?), the opt-out states may create financial problems for hospitals that depend on disproportionate share payments to cover part of their costs for providing non-reimbursed services to the indigent and uninsured.  The Affordable Care Act’s decrease in disproportionate share payments to hospitals is not changed by the Supreme Court’s ruling. More >

Tags: Health Care Law
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