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McBrayer Blogs
Showing 63 posts from 2015.
Pharmacists: Aren’t you really providers already? - Part One
While the passage of the Patient Protection and Affordable Care Act (“ACA”) ushered in a new era of access to health care, it only served to exacerbate a growing crisis in the provision of health care – lack of providers. As of April 2015, the Health Resources and Services Administration lists the population of the United States that lives within a health professional shortage area (“HPSA”) for primary care as 103,847,716, with 1,023,989 of those living in Kentucky.[1] This shortage calls for a reimagining of ways that non-physician providers can fill the care gap, and the debate surrounding the provider status of pharmacists with regard to federal health care programs is evidence of a changing mindset. More >
Five Things to Know about Transitional Care Management
Tuesday’s post discussed the basics of Transitional Care Management (“TCM”), but today’s post will focus on five things that providers should know about TCM. More >
HEALTHCARE NEWS ALERT: Congress Passes Repeal of Sustainable Growth Rate
In a 92-8 vote on Tuesday, the Senate passed a bipartisan measure to repeal the Medicare payment formula known as the Sustainable Growth Rate. This bill was part of a deal negotiated in the House between House Speaker John Boehner and Minority Leader Nancy Pelosi in March, and it was approved with equally overwhelming numbers in that chamber. President Obama is expected to sign the legislation, which prevents health care providers from receiving a 21 percent cut in Medicare reimbursement rates. The bill will also fund the Children’s Health Insurance Program and community health centers for two further years. To pay for the bill, high-income seniors will cover more of their Medicare costs out of pocket, and Medigap plans will require basic co-payments. More >
Five Key Elements of Transitional Care Management
Similar to rules providing billing opportunities for chronic care management (as discussed in this McBrayer blog post), relatively new Medicare funds for Transitional Care Management (“TCM”) provide a new path for providers to supplement their Medicare practice with payment for services they may already provide. Beginning in 2013, Medicare, for the first time, allowed providers to bill for thirty days of TCM, incentivizing post-discharge care with an aim to prevent hospital readmission. The Center for Medicare and Medicaid Services (“CMS”) requires five specific elements of TCM to be met before provider reimbursement. Those elements merit review and brief discussion today, while Thursday’s post will discuss five important points of consideration with regard to TCM. More >
Certificate of Need Modernization in Kentucky
The Certificate of Need (“CON”) program is a regulatory review process used to promote responsive health facility and service development, rational health planning, health care quality, access to health care, and health care cost containment. Since its beginning as part of the federal Health Planning Resources Development Act of 1974, states have both developed and repealed respective CON programs. Currently, approximately 36 states, including Kentucky, retain some type of CON requirements for certain health care providers and services. More >
Important Recommendations from the MedPAC March Report to Congress, Part Two
Important Recommendations from the MedPAC March Report to Congress, Part Two More >
Important Recommendations from the MedPAC March Report to Congress, Part One
Each March, the Medicare Payment Advisory Commission (“MedPAC” or the “Commission”) is tasked with reporting to Congress on the current state of the Medicare fee-for-service (“FFS”) payment systems, the Medicare Advantage (“MA”) program and the Medicare prescription drug program (“Part D”). This report gives lawmakers recommendations on ways to improve and enhance the Medicare system, as well as shore up areas of concern. This year’s report again struck at the root of systemic problems, specifically noting that an increasing issue within Medicare is a fundamental problem with FFS payment systems – the system incentivizes the delivery of more services without taking into account the value of those additional services. Several reforms in the report are the subject of current Congressional legislation as well. In the posts for both today and Thursday, we’ll parse the various statements and recommendations in MedPAC’s March report with an eye for their effect on the workings of the system. More >
Should Health Care Providers Pay Attention to the Seventh Circuit’s New Definition of “Referral”? - Part Two
Tuesday’s post discussed the Seventh Circuit’s holding in United States v. Patel, broadly expanding the definition of “referring” under the Anti-Kickback Statute. Today’s post turns to the question of how other circuits have dealt with the issue. More >
Should Health Care Providers Pay Attention to the Seventh Circuit’s New Definition of “Referral”? - Part One
The Seventh Circuit Court of Appeals, in the case of United States v. Patel[1], just expanded the definition of “referring” under the federal Anti-Kickback Statute[2] (“Statute”). In light of this case, health care providers should again review any arrangements with their peers and colleagues, as previous arrangements may now be considered illegal under the Statute. More >
Lessons Learned from Recent Data Security Breaches, Part Two
In Tuesday’s post, I discussed how the recent data breaches at Anthem, Inc. and Target occurred. Today’s post will turn to the implications of these breaches under HIPAA/HITECH rules and what health providers can learn from them. More >
