HIPAA: Conversion to Version 5010

As of January 1, 2012, all healthcare providers were required to transition from version 4010/4010A to version 5010 standards for submitting electronic transactions, and the failure to comply may result in claim denials or a government investigation. CMS has repeatedly postponed enforcement, but it appears the agency will begin to enforce civil monetary penalties against […]

New York State’s Efforts to Reform Out-of-Network Payments

The New York State Legislature introduced a bill (S.5068A/A.7489B) to address benefit coverage for out-of-network care by health insurers.  The stated purpose of the bill is to protect enrollees that purchase premiums to permit choice and cover the cost of treatment by out-of-network providers, but who are still faced with sometimes expensive and unexpected out […]

PHHPC Passes Emergency Rule to Lift Moratorium on CHHA

The Public Health and Health Planning Council (PHHPC) of the New York State Department of Health (DOH) approved an emergency rule that will lift the State’s moratorium on accepting applications for new Certified Home Health Agencies (CHHAs) since 1994.  The state’s goal is to ensure there is enough CHHA capacity to accommodate the Medicaid Redesign […]

President’s Deficit Reduction Plan Proposes $42 Billion Cut to SNFs, Post-Acute Care Providers

President Obama’s recently released deficit reduction plan proposes to cut more than $320 billion dollars in Medicare and Medicaid spending over the next decade.  Within the planned cuts are proposals designed to curb $42 billion dollars of Medicare reimbursement to SNFs and other post-acute facilities.  According to the President, expenditures for services these facilities provide […]

NYS DOH Extends Health Home Application Deadline to October 3, 2011

The New York State Department of Health (DOH) recently announced that it is extending the filing deadline from September 1 to October 3, 2011 for submission of applications by organizations interested in participating in the new Health Home program being established under New York’s Medicaid program.

Federal Decision Shows Inability to Rely upon CMS Approval

A recent decision by the U.S. District Court for the Middle District of Tennessee has significant implications on provider arrangements structured in reliance on the knowledge and approval of the Centers for Medicare and Medicaid Services (CMS). In U.S. ex rel. Williams v. Renal Care Group, the court analyzed the corporate structure between RCG Supply Company […]

CMS Proposes Rules for New ACOs

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) proposed much-anticipated rules under the Patient Protection and Affordable Care Act (PPACA) to regulate new Accountable Care Organizations (ACOs).  According to CMS, ACOs are groups of health care providers that “work together to treat an individual patient across care settings, including doctor’s offices, […]

CMS Screening Protocols for Enrolling and Revalidating Providers Effective March 23

The Affordable Care Act of 2010 required the Centers for Medicare and Medicaid Services (CMS) to establish standards for screening Medicare, Medicaid, and CHIP providers, suppliers and eligible professionals based upon the level of risk associated with the category of provider.  CMS has identified three categories of risk—“limited,” “moderate” and “high”—and the type of providers, suppliers […]

American Medical Association Introduces New Policy on the Use of Social Media

The American Medical Association (AMA) recently approved a policy for physician’s use of social media.  This policy is available here.  The AMA noted that while “social networking and other similar Internet opportunities . . . enable individual physicians to have a professional presence online” they also “create new challenges to the patient-physician relationship.” In an […]