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Category Archives: Regulations

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Providers Get Short Reprieve on New CMS Two-Midnight Rule on Hospital Stays

Posted in Hospitals, Medicaid, Regulations

The new CMS “Two-Midnight Rule,” which is intended to provide greater clarity regarding when inpatient hospital admissions are generally appropriate for Medicare Part A payment, goes into effect today. However, in order to address widespread concern among hospitals and doctors about the new rule, CMS officials announced last Thursday that government recovery auditors will delay… Continue Reading

Health Data – The Newest Platform for Innovation

Posted in Regulations

In a New York Times column, Obamacare’s Other Surprise, Thomas L. Friedman wrote that health data is “creating a new marketplace and platform for innovation – a health care Silicon Valley – that has the potential to create better outcomes at lower costs.”  The growth of this new industry is due, in large part, to… Continue Reading

Effective Compliance Plans: Have they ever been more important to your organizations?

Posted in Hospitals, Physicians and Group Practices, Regulations

Last month, the Department of Justice (DOJ) announced that it had entered into a $25.5 million settlement with Intermountain Health Care, Inc. (Intermountain), Utah’s largest health system with 22 hospitals and more than 4,500 physicians, to resolve self-reported violations of the Stark Law and the False Claims Act. The claims at issue primarily involved compensation… Continue Reading

OIG Releases Updated Self-Disclosure Protocol

Posted in Regulations

The Office of Inspector General (OIG) released an updated provider self-disclosure protocol (SDP) last week, which replaces the original SDP issued in 1998 and various OIG Open Letters that provided additional guidance on the program. The OIG outlined what it considers to be some significant benefits to disclosing potential fraud through the SDP: The OIG… Continue Reading

IRS Issues Proposed Regulations on Section 501(r) Community Health Needs Assessments

Posted in Hospitals, Regulations

Section 501(r) was added to the Internal Revenue Code by the Patient Protection and Affordable Care Act in order to expand and clarify the federal requirements for tax-exempt hospitals by establishing new standards relating to community health needs assessments; financial assistance policies; and hospital charges, billing, and collection practices. The IRS has issued proposed regulations… Continue Reading

HIPAA Final Omnibus Rule Brings “Sweeping Changes” to the Health Care Industry

Posted in Hospitals, Physicians and Group Practices, Regulations

The long wait for the HIPAA Final Omnibus Rule is finally over, and it covers a broad range of HIPAA issues, including: The Breach Notification Rule; The HIPAA Enforcement Rule, implementing changes mandated by the HITECH Act; The Privacy and Security Rules, implementing changes mandated by the HITECH Act, as well as other changes to… Continue Reading

No State-Run Health Insurance Exchange or Medicaid Expansion in Alabama

Posted in Affordable Care Act, Medicaid, Regulations

Governor Bentley told the Birmingham Business Alliance today that he would not set up a state-run health insurance exchange, and he will not expand Medicaid as provided under health care reform. Once established, the health insurance exchanges will be places for individuals and businesses to shop for health insurance plans.  The exchanges are supposed to be… Continue Reading

President Obama’s Reelection Ensures the Path of Health Care Reform

Posted in Affordable Care Act, Medicaid, Regulations

In its front-page story on President Obama’s reelection, the New York Times reports, “For Mr. Obama, the result brings a ratification of his sweeping health care act, which Mr. Romney had vowed to repeal.  The law will now continue on course toward nearly full implementation in 2014, promising to change significantly the way medical services… Continue Reading

Two “Pay-For-Performance” Provisions of the Affordable Care Act Go Into Effect Oct. 1, 2012

Posted in Administration, Affordable Care Act, Hospitals, Medicaid, Regulations

Two major but less discussed programs under the Affordable Care Act took effect October 1, 2012, which are part of the government’s effort to deliver better quality health care.  Both programs aim to reward hospitals for providing more efficient and higher quality care and penalize those that don’t. Under the Hospital Value-Based Purchasing Program, Medicare… Continue Reading

Health Care Reform: My Two Cents

Posted in Regulations

After the dust has settled from the Supreme Court’s upholding of the Accountable Care Act, one key takeaway from the provider perspective appears to be reimbursement strategy. Providers must continue to determine how best to absorb looming reimbursement cuts and to benefit from the different payment methodologies. However, it remains uncertain whether the anticipated increase… Continue Reading

CMS Releases Three-Day Payment Window FAQs

Posted in Administration, Hospitals, Physicians and Group Practices, Regulations

On July 9, 2012, the Centers for Medicare and Medicaid Services (“CMS”) posted 43 frequently asked questions (“FAQs”) addressing various issues concerning the 3-day Payment Window Rule (the “Rule”).  As background, the Rule applies to outpatient services furnished (1) by a hospital or (2) by another Part B supplier (referred to herein as a “Physician… Continue Reading