Contact Us
Subscribe to this blog via RSS
Join us on LinkedInCategories
- Workplace Violence
- Assisted Living Facilities
- Department of Health and Human Services' Office of Civil Rights
- Medical Residents
- EMTALA
- FDA
- Reproductive Rights
- Roe v. Wade
- SCOTUS
- Medical Spas
- medical billing
- No Surprises Act
- Mandatory vaccination policies
- Workplace health
- Coronavirus Aid, Relief and Economic Security Act
- Code Enforcement
- Department of Labor ("DOL")
- Employment Law
- FFCRA
- CARES Act
- Nursing Home Reform Act
- COVID-19
- SB 150
- Acute Care Beds
- Clinical Support
- Coronavirus
- Emergency Medical Services
- Emergency Preparedness
- Families First Coronavirus Response Act
- Family and Medical Leave Act (“FMLA”)
- KBML
- medication assisted therapy
- Department of Health and Human Services
- Legislative Developments
- Corporate
- United States Department of Justice ("DOJ")
- Employee Contracts
- Non-Compete Agreement
- Opioid Epidemic
- Sexual Harassment
- Health Resource and Services Administration
- Litigation
- Medical Malpractice
- House Bill 333
- Senate Bill 79
- Locum Tenens
- Senate Bill 4
- Physician Prescribing Authority
- HIPAA
- Chronic Pain Management
- Prescription Drugs
- "Two Midnights Rule"
- 340B Program
- EHR Systems
- Electronic Health Records (“EHR")
- Hospice
- ICD-10
- Kentucky minimum wage
- Minimum wage
- Primary Care Physicians ("PCPs")
- Skilled Nursing Facilities (“SNFs”)
- Uncategorized
- Affordable Insurance Exchanges
- Compliance
- Department of Health and Human Services (HHS)
- Drug Screening
- Fraud
- Health Care Fraud
- HIPAA Risk Assessment
- KASPER
- Kentucky Board of Medical Licensure
- Kentucky’s Department for Medicaid Services
- Mental Health Care
- Office for Civil Rights ("OCR")
- Office of Inspector General of the United States Department of Health and Human Services (OIG)
- Physician Assistants
- Qui Tam
- Stark Laws
- Urinalysis
- Accountable Care Organizations (“ACO”)
- Affordable Care Act
- Alternative Payment Models
- Anti-Kickback Statute
- Centers for Medicare & Medicaid Services (“CMS”)
- Certificate of Need ("CON")
- Charitable Hospitals
- Data Breach
- Electronic Protected Health Information (ePHI)
- False Claims Act
- Federally Qualified Health Centers (“FQHCs”)
- Fee for Service
- Health Information Technology for Economic and Clinical Health Act (HITECH Act)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Health Professional Shortage Area ("HPSA")
- Hospitals
- HPSA
- HRSA
- Limited Services Clinics
- Medicaid
- Medical Staff By-Laws
- Medically Underserved Area ("MUA")
- Medicare
- Mid-Level Practitioners
- Part D
- Patient Protection and Affordable Care Act (“ACA”)
- Pharmacists
- Rural Health Centers (“RHCs”)
- Rural Health Clinic
- Telehealth
- American Telemedicine Association (“ATA”)
- Criminal Division of the Department of Justice (“DOJ”)
- Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)
- Hydrocodone
- Kentucky Board of Nursing
- Kentucky Pharmacists Association
- Qualified Health Care Centers (“FQHC”)
- Telemedicine
- United States ex. Rel. Kane v. Continuum Health Partners
- Webinar
- Agreed Order
- APRNs
- Chain and Organization System (“PECOS”)
- Douglas v. Independent Living Center of Southern California
- Drug Enforcement Agency ("DEA")
- Emergency Rooms
- Enrollment
- Hinchy v. Walgreen Co.
- Jimmo v. Sebelius
- Kentucky Senate Bill 7
- Maintenance Standard
- Medicare Part D
- Minors
- Overpayments
- Re-validation
- Texting
- Vitas Innovative Hospice Care
- 2014 Medicare Physician Fee Schedule (“PFS”)
- 501(c)(3)
- All-Payer Claims Database ("APCD")
- Appeal
- Centers for Disease Control and Prevention
- Chiropractic services
- Chronic Care Management
- Clinical Laboratory Improvement Amendments of 1988 (“CLIA”)
- Compliance Officer
- Compounding
- CPR
- Dispenser
- Drug Quality and Security Act (“DQSA”)
- Essential Health Benefits
- Federation of State Medical Boards (“FSMB”)
- Food and Drug Administratio
- HealthCare.gov
- House Bill 3204
- ICD-9
- Kentucky Medical Practice Act
- Kindred v. Cherolis
- Kynect
- Long-term care communities
- Mobile medical applications ("apps")
- Model Policy for the Appropriate Use of Social Media and Social Networking in Medical Practice (“Model Policy”)
- National Drug Code ("NDC")
- National Institutes of Health
- New England Compounding Center ("NECC")
- Ophthalmological services
- Outsourcing facility
- Physician Compare website
- Ping v. Beverly Enterprises
- Power of Attorney ("POA")
- Prescriber
- Social Media
- State Health Plan
- Sustainable Growth Rate (“SGR”)
- "Plan of Correction"
- Advanced Practice Registered Nurses
- Affinity Health Plan
- Arbitration
- Audit
- Cadillac tax
- Call Coverage
- Community health needs assessment (“CHNA”)
- Condition of Participation ("CoP")
- Daycare centers
- Decertification
- Denied Claims
- Department of Medicaid Services’ (“DMS”)
- Division of Regulated Child Care
- Doe v. Guthrie Clinic
- EHR vendor
- Employer Group Health Plans
- Employer Mandate
- ERISA
- Fair Labor Standards Act (FLSA)
- False Billings
- Form 4720
- Grace Period
- Group Purchasing Organizations ("GPO")
- Health Professional Shortage Areas (“HPSA”)
- Health Reform
- Home Health Prospective Payment System
- Home Medical Equipment Providers
- Hospitalists
- House Bill 104
- Individual mandate
- Inpatient Care
- Intermediate Sanctions Agreement
- Kentucky Health Benefit Exchange
- Licensed practical nurses (LPN)
- Licensure Requirements
- List of Excluded Individuals and Entities
- LLC v. Sutter
- Long-Term Care Providers ("LTC")
- Low-utilization payment adjustment ("LUPA")
- Meaningful use incentives
- Medicare Administrative Coordinators
- Medicare Benefit Policy Manual
- Medicare Shared Saving Program (MSSP)
- Network provider agreement
- Nonprofit hospitals
- Nonroutine medical supplies conversion factor (“NRS”)
- Nurse practitioners (NP)
- Office of the National Coordinator for Health Information Technology (“ONC”)
- Part A
- Part B
- Patient Privacy
- Payors
- Personal Service Entities
- Physician Payments
- Physician Recruitment
- Physician shortages
- Provider Self Disclosure Protocol
- Qualified Health Plan ("QHP")
- Quality reporting
- Registered nurses (RN)
- Residency Programs
- Self-Disclosure Protocol
- Spousal coverage
- Statement of Deficiency ("SOD")
- Trade Association Group Coverage
- Upcoding
- UPS
- “Superuser”
- Autism/ASD
- Business Associate Agreements
- Business Associates
- Center for Disease Control
- Compliance Programs
- Critical Access Hospitals (“CAHs”)
- Essential Health Benefits (“EHBs”)
- Genetic Information Nondiscrimination Act ("GINA")
- Healthcare Information and Management Systems Society (HIMSS)
- Kentucky House Bill 159
- Kentucky House Bill 217
- Kentucky Primary Care Centers (“PCCs”)
- Managed Care Organizations (“MCOs”)
- Medicare Audit Improvement Act of 2012
- Patient Autonomy
- Personal Health Information
- Recovery Audit Contractors (“RAC”)
- Senate Bill 39
- Senate Finance Committee Report
- Small Business Health Options Program (“SHOP”)
- State Medicaid Expansion
- Sunshine Act
- Abuse and Waste
- Consumer Operated and Oriented Plan programs (“CO-OPS”)
- Free Conference Committee Report
- Health Care Fraud and Abuse Control Program
- House Bill 1
- House Bill 4
- Kentucky Cabinet for Health and Family Services
- Kentucky Health Care Co-Op
- Kentucky Health Cooperative (“KYHC”)
- Kentucky “Pill Mill Bill”
- Occupational Safety and Health Administration (“OSHA”)
- Pain Management Facilities
- Employee Agreement
- Health Care Law
- Health Insurance
- Healthcare Regulation
McBrayer Blogs
Part II: Understanding All-Payer Claims Databases
Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems. Nine states currently have APCDs in place, but Kentucky is not one of them. These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs?
APCDs were developed before the enactment of the Affordable Care Act, but with the subsequent national focus on quality and cost containment, it is easy to see why these systems have gained tremendous popularity in recent years.
Still, providers should be aware of the information shared through APCDs. Every system is different, and states can largely tailor how the information gathered will be used and analyzed. What protections should be afforded to providers? In Maine, for example, there are specific restrictions on data which would reveal provider discount arrangements with payers.[1]
Questions to which providers should seek answers include: will the information gathered accurately reflect quality and pricing? Can the complexity of individual cases be relayed through the system’s coding? Will providers be able to protect their patients’ personal information, such as their age and condition? If APCD is made available to the public, what will be done to encrypt or eliminate such information?
Despite these concerns, providers may reap many of the benefits associated with APCDs. When an APCD is established, providers can rely on the system to assess expenditures and quality improvement efforts – a necessary undertaking for any health care entity, big or small. Providers can compare how different payers compensate for the same or similar services, compare their rates to other providers in the area, and assess the overall care that is afforded to their patients.
In short, APCDs offer great information, but providers should actively participate in any grass-roots movements or legislative efforts to implement a system. Providers should ensure that a system will work to their benefit, not their detriment.
[1] Robert Wood Johnson Foundation, “The Basics of All-Payer Claims Databases,” January 2014.
Services may be performed by others.
This article does not constitute legal advice.
