Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Part 2
- Data Privacy
- Department of Health and Human Services' Office of Civil Rights
- Medical Malpractice
- Medical Cannabis
- Workplace health
- Workplace Violence
- Assisted Living Facilities
- EMTALA
- FDA
- Reproductive Rights
- Roe v. Wade
- SCOTUS
- COVID-19
- Prescription Drugs
- Telemedicine
- Medical Spas
- Code Enforcement
- Corporate
- Employee Contracts
- Non-Compete Agreement
- United States Department of Justice ("DOJ")
- Compliance
- HIPAA
- Kentucky Board of Nursing
- Managed Care Organizations (“MCOs”)
- Anti-Kickback Statute
- False Claims Act
- KASPER
- Kentucky’s Department for Medicaid Services
- Medicaid
- Mental Health Care
- Office for Civil Rights ("OCR")
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Primary Care Physicians ("PCPs")
- Qui Tam
- Stark Laws
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- APRNs
- Centers for Medicare & Medicaid Services (“CMS”)
- Charitable Hospitals
- Data Breach
- Electronic Protected Health Information (ePHI)
- Federally Qualified Health Centers (“FQHCs”)
- 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
- HPSA
- HRSA
- Kentucky Board of Medical Licensure
- Medicare
- Mid-Level Practitioners
- Patient Protection and Affordable Care Act (“ACA”)
- Pharmacists
- Physician Assistants
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- Business Associate Agreements
- Fraud
- Part D
- Appeal
- Compliance Programs
- Electronic Health Records (“EHR")
- ERISA
- Hospice
- Overpayments
- Advanced Practice Registered Nurses
- Business Associates
- Denied Claims
- Division of Regulated Child Care
- Employee Agreement
- Fair Labor Standards Act (FLSA)
- Licensed practical nurses (LPN)
- Licensure Requirements
- Nurse practitioners (NP)
- Part A
- Part B
- Personal Health Information
- Personal Service Entities
- Physician Payments
- Qualified Health Plan ("QHP")
- Registered nurses (RN)
- Abuse and Waste
- Occupational Safety and Health Administration (“OSHA”)
- Patient Autonomy
- Department of Health and Human Services (HHS)
- Health Insurance
- Healthcare Regulation
- Health Care Law
McBrayer Blogs
Part II: Understanding All-Payer Claims Databases
Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems. Nine states currently have APCDs in place, but Kentucky is not one of them. These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs?
APCDs were developed before the enactment of the Affordable Care Act, but with the subsequent national focus on quality and cost containment, it is easy to see why these systems have gained tremendous popularity in recent years.
Still, providers should be aware of the information shared through APCDs. Every system is different, and states can largely tailor how the information gathered will be used and analyzed. What protections should be afforded to providers? In Maine, for example, there are specific restrictions on data which would reveal provider discount arrangements with payers.[1]
Questions to which providers should seek answers include: will the information gathered accurately reflect quality and pricing? Can the complexity of individual cases be relayed through the system’s coding? Will providers be able to protect their patients’ personal information, such as their age and condition? If APCD is made available to the public, what will be done to encrypt or eliminate such information?
Despite these concerns, providers may reap many of the benefits associated with APCDs. When an APCD is established, providers can rely on the system to assess expenditures and quality improvement efforts – a necessary undertaking for any health care entity, big or small. Providers can compare how different payers compensate for the same or similar services, compare their rates to other providers in the area, and assess the overall care that is afforded to their patients.
In short, APCDs offer great information, but providers should actively participate in any grass-roots movements or legislative efforts to implement a system. Providers should ensure that a system will work to their benefit, not their detriment.
[1] Robert Wood Johnson Foundation, “The Basics of All-Payer Claims Databases,” January 2014.
Services may be performed by others.
This article does not constitute legal advice.
