Healthcare Law Blog

Primary Care Providers – Are you feeling the pinch?

It was nice while it lasted – due to a provision of the Patient Protection and Affordable Care Act (“ACA”), services furnished by certain primary care providers (“PCPs”) were subject to an enhanced payment rate for Calendar Years 2013 and 2014. These PCPs had to have (a) been Board certified in the specialty designation of family medicine, general internal medicine or pediatric medicine or have a subspecialty designation recognized by specific boards or associations, or (b) furnished more than 60% of claims in specific evaluation and management or vaccine administration services under certain codes to have been eligible for these enhanced payments.[1] The payments were raised to the level of the Medicare Part B fee schedule rate (unless the actual billed charge for the service was lower), and providers had until April 1, 2013 to self-attest to being eligible.[2] The increase applied to both fee-for-service and managed care Medicaid plans. More >

The Walmart List: Milk, Eggs, and a Doctor Visit?

By January 2015, Walmart will be operating dozen primary care clinics across the U.S. Six of these have already opened in South Carolina and Texas. Currently, some Walmart stores include acute care clinics that are operated through leases with local hospital operators. The new primary care clinics are distinct from the existing ones in several ways. The new clinics will be fully-owned by Walmart, offer a broader range of services, and be open seven days a week with longer operating hours. Walmart is partnering with QuadMed nationally to operate the clinics, rather than with local partners. The primary care clinics will be staffed primarily by nurse practitioners and medical assistants and will be supervised by a physician. More >

Part I Medicaid Webinar A Success – Register Now for Part II!

On Wednesday, August 20, the McBrayer Health Care Group, along with panelists from the Kentucky Primary Care Association and the Primary Care Centers of Eastern Kentucky, hosted a free webinar entitled, “Medicaid: Getting Paid & Keeping It.”

Part I of the webinar provided an overview of the Medicaid administrative appeal process, the Dispute Resolution Meeting (“DRM”), appeal of the DRM decision, and settlement. In addition, McBrayer attorneys weighed in on the “top issues” they encounter when helping providers work through the complicated reimbursement process. Attendees received real-world advice about what to challenge when an overpayment demand is received and saw examples of actual letters received by others in the industry.

Part II of the webinar is scheduled for Wednesday, August 27 from 12-1:30pm, EST. This session will discuss federal Medicaid audit authority, what to do if you’re contacted by a Medicaid Integrity Contractor (“MIC”), and opportunities to contest a MIC’s auditor’s adjustment/denials/identification of overpayment.

Attendees of Part I will automatically be enrolled in Part II. If you missed Part I, but would like to take part in next week’s webinar, sign up here: https://attendee.gotowebinar.com/register/6389912240505419777.

Services may be performed by others.

This article does not constitute legal advice.

Medicare Physician Fee Schedule Final Rule Issued for CY 2014

The CY 2014 Medicare Physician Fee Schedule (“PFS”) final rule has been issued. The rule, over 1,000 pages in length, determines physician reimbursement for services provided to Medicare beneficiaries. Let’s take a look at just a few of the changes contained therein. 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 >