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6 May 2019, 5:44 pm
Health plans, their sponsoring employers and unions, insurers, fiduciaries, administrators, insurers and other service providers should learn from the $3 million lesson a Franklin, Tennessee-based diagnostic medical imaging services provider is learning about the heavy penalties a health plan, health care provider, health care clearinghouse or business associate (“Covered Entity”) risks if a post-data breach investigation by the U.S. [read post]
29 May 2023, 10:00 am
Medicare Advantage Plans are Aggressively Denying Claims – Administrative Appeals are Growing (May 25, 2023): According to the latest data released by the Centers for Medicare and Medicaid Services (CMS), beneficiaries participating in Medicare Advantage[1] plans now surpass those enrolled in original Medicare plans. [read post]
10 Sep 2018, 7:49 pm
House Republicans are taking action to make permanent the individual and small business tax cuts enacted under the Tax Cuts and Jobs Act (TCJA) by introducing the following three bills to accomplish Republicans’ Tax Reform 2.0 package: H.R. 6760, the Protecting Family and Small Business Tax Cuts Act of 2018, sponsored by Rep. [read post]
10 Oct 2023, 10:51 am
During FY 2022, the Centers for Medicare and Medicare Services (CMS) has estimated the Medicare Part B improper payment rate as 8.41%. while the improper payment rate for Durable Medical Equipment (DME) suppliers was estimated to be 25.24%.[2] Additionally, the Medicaid program improperly paid $80.6 billion in improper claims during FY 2022.[3] Notably, these estimates don’t even take into account the sizeable improper billings submitted to private payors. [read post]
26 Sep 2022, 3:46 am
Incident To Billing Practices are Under Law Enforcement’s Microscope. [read post]
7 Feb 2019, 3:03 pm
Health plans and their employer and other sponsors, fiduciaries, administrators and other service providers, as well as health care providers, health care clearinghouses and their business associates (“Covered Entities”) should reconfirm the adequacy of their Health Insurance Portability and Accountability Act (“HIPAA”) compliance and risk management in light the U.S Department of Health and Human Services Office of Civil Rights (“OCR”) February 7, 2019… [read post]
30 Apr 2019, 10:23 am
Health plans must deliver electronic protected health information (“ePHI”) to electronic applications or software (“apps”) used by plan members, and are responsible under the Health Insurance Portability & Accountability Act (“HIPAA”) Privacy and Security Rules for the security of electronic protected health information (“ePHI”) on apps they sponsor or provide, according to new guidance from the Department of Health & Human Services… [read post]
15 Dec 2018, 7:41 am
A ruling by a Federal District judge on Friday (December 14, 2018) ruled unconstitutional the Patient Protection and Affordable Care Act (ACA) touches off a new wave of uncertainty about the future of the massive healthcare reform law commonly known as Obamacare just as the enrollment period for 2019 health coverage ended. [read post]
10 May 2017, 3:14 pm
Healthcare providers, health plans, healthcare clearinghouses and their business associates (Covered Entities) can’t disclose the name or other protected health care information about a patient in press releases or other announcements without prior authorization from the patient. [read post]
13 Jul 2018, 10:37 pm
A flurry of activity in the House Ways & Means Committee and other Congressional committees over the past few weeks signals the advisability of keeping a close eye on health care and health benefit reform proposals this Summer in anticipation of both the Fall health benefit enrollment and renewal season and the mid-term November Congressional elections. [read post]
24 Apr 2017, 5:08 pm
Health plans, their fiduciaries and sponsors, health insurers, health care providers, health care clearinghouses (“covered entities”) and their business associates must get and keep your business associate (BA) agreements (BAAs) in place, up- to-date, and readily available for inspection in accordance with the Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule, 45 C.F.R. [read post]
20 May 2018, 2:26 pm
An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions (May 20, 2018): It’s been a rough week for at least one Texas rheumatologist. [read post]
18 Nov 2018, 8:30 pm
Self-insured employer and union sponsored health plans, health insurers and other health care payers, health care providers, managed care and practice management service providers and others structuring or working with preferred provider or other managed health care contracts should weigh the potential implications on their health plan provider agreements and managed care practices of the antitrust lawsuit jointly brought by the U.S. [read post]
20 May 2018, 2:26 pm
An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions (May 20, 2018): It’s been a rough week for at least one Texas rheumatologist. [read post]
26 Apr 2017, 6:14 pm
A new Department of Health and Human Services Office of Civil Rights (OCR) CardioNet Resolution Agreement and Corrective Action Plan (Resolution Agreement) settling OCR charges of violations of the Privacy and Security Rules of the Health Insurance Portability & Accountability Act against remote cardiac monitoring provider CardioNet provides important lessons for health plans, health insurers telemedicine and other healthcare providers, healthcare clearinghouses (Covered… [read post]
8 Jan 2019, 12:38 pm
Interoperability will be a key priority for the Office of the National Coordinator for Health Information Technology (“ONC”) going forward. [read post]
5 Dec 2007, 7:39 am
The New York Cerebral Palsy Resource Guide contains resources for individuals with cerebral palsy within the State of New York. [read post]
