U.S. Supreme Court Upholds Key Provisions of PPACA in Historic Decision

The U.S. Supreme Court on June 29, 2012 upheld almost all portions of the Patient Protection and Affordable Care Act (“PPACA”) being challenged on the basis of Constitutionality. The two provisions before the Court were the Medicaid expansion requirements and the “shared responsibility payment” also called the “individual mandate,” which must be paid by all […]

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AHA Rejects Proposed Readmission Penalties

The American Hospital Association (“AHA”) expressed staunch opposition in a 62-page letter to the Centers for Medicare & Medicaid Services (“CMS”) regarding CMS’s proposed rules levying a penalty up to 1% of reimbursement for higher readmission rates. Part of the reasoning behind the AHA’s opposition is the fact that the proposed rule does not exclude […]

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ONC Posts EHR Privacy and Security Guide

The Office of the National Coordinator has posted an electronic health records (EHRs) Privacy and Security containing valuable information about privacy and security in using electronic health records. The guide is designed to help healthcare practitioners, staff, and other professionals better understand the important role privacy and security play in the use of EHR and […]

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CMS Rule Proposes to Place Medicaid Rates on Par with Medicare Rates for Primary Care

The Centers for Medicare & Medicaid Services (“CMS”) issued May 8 a proposed rule that would implement a provision of the Affordable Care Act requiring Medicaid to reimburse family medicine, general internal medicine, pediatric medicine, and related subspecialists on par with Medicare rates in 2013 and 2014. The increase in Medicaid payments will be funded […]

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CMS Releases Rules to Relieve Administrative Burdens

The Centers for Medicare & Medicaid Services (“CMS”) today released a final regulation to revise the existing Conditions of Participation for hospitals and critical access hospitals. In addition, it released a final rule that addresses more than two dozen regulatory requirements for a broader range of providers, including hospitals, ambulatory surgical centers, end-stage renal disease […]

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Medical Identity Theft on the Rise

According to a report from the professional services firm PwC, one-third of health care organizations have reported catching a patient using the identity of someone else to obtain services.  PwC stated that preventing medical identity theft requires a provider that is committed to privacy of patient information, even beyond following federal standards such as HIPAA. […]

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North Carolina Medicaid Alleges Fraud on Part of Mental Health Provider

North Carolina has suspended Medicaid payments to health care provider in Boone, North Carolina with thousands of clients following allegations of fraud. New River Behavioral Healthcare (“New River”) has not received Medicaid payments since October 4, 2011 after a letter from the state Division of Medical Assistance alleged that at least four examples of fraud […]

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OIG Publishes 2012 Work Plan

On October 5, 2011, the Office of the Inspector General (“OIG”) revealed plans for 2012 in its 2012 Work Plan that call for even closer scrutiny of the healthcare industry. In the Work Plan, the OIG states that it plans “to use data-mining techniques to review” those “hospitals deemed ‘high risk’ to submit improper bills […]

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IRS Official States that Area Hospitals May Work Together in Performing Their Community Health Needs Assessments

An Internal Revenue Service (“IRS”) official on October 4, 2011 said multiple hospitals in one community can work together when performing their community health needs assessments (CHNAs) as long as they develop individual final assessments and implementation plans for each facility. One of the questions raised in the comments to the IRS’s notice of proposed […]

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CMS Publishes Final Rule for Privileging and Credentialing Telemedicine Providers

Effective July 5, 2011, CMS will permit hospitals to credential and grant clinical privileges to a telemedicine practitioner based upon the credentialing and privileging decisions of another entity who provides the telemedicine services. If it so chooses, the hospital where the patient is located will no longer be required by CMS to independently verify and […]

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