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McBrayer Blogs
Showing 179 posts in Health Care Law.
UPS Denies Insurance Coverage of Spouses and Cites ACA as Reason
The United Parcel Service (“UPS”) recently made a big statement when they decided to drop 15,000 working spouses eligible for health coverage through their own employers from the UPS plan in 2014. The shipping conglomerate explained the change in a memo to its workers and repeatedly cited the Affordable Care Act (“ACA”) as the reason for the new policy. Rising medical costs “combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost,” the memo stated. The new policy will not affect union workers, as their health benefits are already spelled out in labor contracts, but will apply to about a quarter of the UPS U.S. workforce. More >
The ACA Loophole Of Which Providers Should Be Aware, Part II
Earlier this week, we discussed the three-month grace period afforded to enrollees of qualified health plans (“QHPs”). To recap that article, the ACA requires that QHPs pay claims for the first thirty days of the grace period during which premium payment remains unpaid, but issuers may pend claims for the final sixty days of the grace period. If the balance remains unpaid, the issuer may deny any claims submitted within the final sixty days. More >
Clarifying the “Two-Midnight Rule” and Part A Payments, cont.
Earlier this week, I discussed CMS’ final rule on the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. The final rule provides guidance to physicians on how to designate a patient as inpatient or outpatient and the impact of the designation on Medicare Part A or Part B coverage. This blog will discuss the two midnight rule. More >
PHI May Be In More Places Than You Think
A recent HIPAA settlement serves as an important reminder that protected health information (PHI) may be stored on “ordinary” office equipment such as printers, photocopiers, scanners and fax machines, and not just on computer hard drives. On August 14, 2013, the Department of Health and Human Services (HHS) announced a settlement with the not-for-profit managed care plan Affinity Health Plan, Inc. (“Affinity”) for over $1.2 million in connection with HIPAA Privacy and Security breaches stemming from PHI stored on a photocopier hard drive. More >
Licensure Requirements for Home Medical Equipment Providers, Personal Service Agencies
It is no surprise that, given the current health care climate, providers who were unregulated just a few years ago are now subject to certification and licensure requirements. More >
Final Rule for Long-Term Care Facilities and Hospice Providers Becomes Effective August 26th
On June 27, 2013, CMS published its final rule for hospice agreements with long-term care (“LTC”) providers. LTC facilities are now required to have written agreements specifying what services the hospice and LTC provider will provide to nursing home residents receiving hospice care. This new Condition of Participation (CoP) aims to improve the quality and consistency of care between LTC and hospice providers by specifically defining responsibilities and roles. The agreement must be signed by authorized representatives for both the LTC facility and hospice before hospice care can be provided to patients. The effective date is August 26, 2013. More >
Beyond Making the Rounds: Hospitalists & Quality of Care under the ACA, cont.
On Tuesday, I discussed how hospitalists play a vital role in meeting the ACA's quality of care standards for the inpatient setting. Now, let's take a look at how PCPs must also work to meet these same standards. More >
Beyond Making the Rounds: Hospitalists & Quality of Care under the ACA
By now, everyone knows the Affordable Care Act’s (“ACA”) motto is “increase quality, decrease costs.” As providers transition from the fee for service payment model to new payment systems that are tied to quality, one subset of providers will play a pivotal role in bringing health care into a new era: hospitalists. More >
Kentucky Selected To Participate in ER “Superusers” Program
If you have ever visited an emergency room in the Commonwealth, chances are that you have seen a “superuser” – a person who uses the emergency room for regular health care instead of opting for a lower-cost alternative such as a primary care physician. Whether Medicaid recipients or uninsured, superusers (also known as “super-utilizers” or “frequent flyers”) increase Medicaid expenditures and drive up the overall costs of health care. In 2012, 4,400 Medicaid recipients used an emergency room ten or more times, and Kentucky Medicaid spent more than $219 million on emergency room use. Superusers, however, do not just waste money. They also waste the valuable time and resources of emergency room providers, creating longer wait times for those experiencing true emergencies. More >
The Pioneer Program Report Card
In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization (“ACO”) program created through the Affordable Care Act (“ACA”). The program’s goals were to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity. More >
