Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- medical billing
- No Surprises Act
- Mandatory vaccination policies
- Workplace health
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- COVID-19
- SB 150
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- KBML
- medication assisted therapy
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- Litigation
- Medical Malpractice
- House Bill 333
- Senate Bill 79
- locum tenens
- Senate Bill 4
- Physician Prescribing Authority
- Chronic Pain Management
- HIPAA
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- EHR Systems
- Hospice
- ICD-10
- Kentucky minimum wage
- Minimum wage
- Primary Care Physicians ("PCPs")
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- Drug Screening
- Electronic Health Records (“EHR")
- Urinalysis
- Affordable Insurance Exchanges
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- KASPER
- Mental Health Care
- Office for Civil Rights ("OCR")
- Qui Tam
- Stark Laws
- Compliance
- Department of Health and Human Services (HHS)
- HPSA
- Kentucky Board of Medical Licensure
- Kentucky’s Department for Medicaid Services
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Pharmacists
- Physician Assistants
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- Medicaid
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Medicare
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- Alternative Payment Models
- Charitable Hospitals
- HRSA
- Kentucky Board of Nursing
- Limited Services Clinics
- Mid-Level Practitioners
- American Telemedicine Association (“ATA”)
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Hydrocodone
- Kentucky Pharmacists Association
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- APRNs
- Chain and Organization System (“PECOS”)
- Jimmo v. Sebelius
- Maintenance Standard
- Overpayments
- Vitas Innovative Hospice Care
- Agreed Order
- Chiropractic services
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Kentucky Senate Bill 7
- Medicare Part D
- Minors
- Ophthalmological services
- Physician Compare website
- Re-validation
- Texting
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- All-Payer Claims Database ("APCD")
- Appeal
- Chronic Care Management
- Compliance Officer
- Compounding
- CPR
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- House Bill 3204
- ICD-9
- Kindred v. Cherolis
- Long-term care communities
- New England Compounding Center ("NECC")
- Outsourcing facility
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Sustainable Growth Rate (“SGR”)
- Affinity Health Plan
- Cadillac tax
- Centers for Disease Control and Prevention
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Denied Claims
- Dispenser
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- Form 4720
- Grace Period
- HealthCare.gov
- Home Medical Equipment Providers
- Individual mandate
- Kentucky Medical Practice Act
- Kynect
- Licensure Requirements
- Long-Term Care Providers ("LTC")
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Drug Code ("NDC")
- National Institutes of Health
- Nonprofit hospitals
- Personal Service Entities
- Physician Payments
- Prescriber
- Qualified Health Plan ("QHP")
- Social Media
- Spousal coverage
- State Health Plan
- UPS
- "Plan of Correction"
- Arbitration
- Audit
- Daycare centers
- Decertification
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- EHR vendor
- Employer Mandate
- Fair Labor Standards Act (FLSA)
- False Billings
- Health Professional Shortage Areas (“HPSA”)
- Home Health Prospective Payment System
- Hospitalists
- Inpatient Care
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Licensed practical nurses (LPN)
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Low-utilization payment adjustment ("LUPA")
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Medicare Shared Saving Program (MSSP)
- Network provider agreement
- Nonroutine medical supplies conversion factor (“NRS”)
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Payors
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Quality reporting
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Statement of Deficiency ("SOD")
- Upcoding
- “Superuser”
- Advanced Practice Registered Nurses
- Autism/ASD
- Business Associate Agreements
- Business Associates
- Call Coverage
- Doe v. Guthrie Clinic
- Employer Group Health Plans
- ERISA
- Group Purchasing Organizations ("GPO")
- Health Reform
- House Bill 104
- Kentucky House Bill 159
- Kentucky House Bill 217
- Patient Autonomy
- Patient Privacy
- Personal Health Information
- Senate Bill 39
- Senate Finance Committee Report
- State Medicaid Expansion
- Trade Association Group Coverage
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Genetic Information Nondiscrimination Act ("GINA")
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Medicare Audit Improvement Act of 2012
- Recovery Audit Contractors (“RAC”)
- Small Business Health Options Program (“SHOP”)
- Sunshine Act
- Abuse and Waste
- Center for Disease Control
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Occupational Safety and Health Administration (“OSHA”)
- Employee Agreement
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Kentucky “Pill Mill Bill”
- Pain Management Facilities
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Showing 4 posts in Part D.
Important Recommendations from the MedPAC March Report to Congress, Part Two
Important Recommendations from the MedPAC March Report to Congress, Part Two More >
Important Recommendations from the MedPAC March Report to Congress, Part One
Each March, the Medicare Payment Advisory Commission (“MedPAC” or the “Commission”) is tasked with reporting to Congress on the current state of the Medicare fee-for-service (“FFS”) payment systems, the Medicare Advantage (“MA”) program and the Medicare prescription drug program (“Part D”). This report gives lawmakers recommendations on ways to improve and enhance the Medicare system, as well as shore up areas of concern. This year’s report again struck at the root of systemic problems, specifically noting that an increasing issue within Medicare is a fundamental problem with FFS payment systems – the system incentivizes the delivery of more services without taking into account the value of those additional services. Several reforms in the report are the subject of current Congressional legislation as well. In the posts for both today and Thursday, we’ll parse the various statements and recommendations in MedPAC’s March report with an eye for their effect on the workings of the system. More >
New Part D Regulations Face Increased Scrutiny from Advocacy Groups & Congress
On March 10, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance" (“Guidance”). The Guidance, effective since May 1, 2014, requires a prior authorization process for Hospice and Part D providers to determine their respective responsibility for drug coverage. The Guidance followed a 2012 OIG report entitled "Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice,” which found that Medicare Hospice patients’ medications were sometimes paid for by Part D rather than by the patient’s Hospice program. More >
Medicare Part D Prescribers Must Act Now
On May 19, the Centers for Medicare & Medicaid Services (“CMS”) issued final regulations which require doctors prescribing drugs for Part D patients to enroll in Medicare. In addition, the regulations establish authority for CMS to revoke a doctor's Medicare eligibility for abusive prescribing practices, among other provisions. The regulations are part of the ongoing effort to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs. More >
