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McBrayer Blogs
Part I: Understanding All-Payer Claims Databases
Over the last decade, many states have established all-payer claims database (“APCD”) systems that collect medical, pharmaceutical, and dental eligibility and claims information. Payers, including insurance providers, third-party administrators, prescription drug plans, Medicaid, and Medicare, are responsible for depositing eligibility and claims data into a collective system. The data can then be used to generate important information about cost and quality of care. By gathering detailed information in one place, a statewide picture emerges – information on service providers, patient demographics, and other important healthcare data. More >
Major Money Marked for Addiction Treatment in Kentucky
The Commonwealth of Kentucky has long suffered from a prescription drug abuse and methamphetamine problem, and heroin use has also been on the rise recently. As a result, more than $32 million is being set aside to help address the growing substance abuse problem in Kentucky. The much-needed funds are a result of settlements with two pharmaceutical companies, according to Attorney General Jack Conway. More >
Part II: Are U.S. Providers Ready to Catch Up in Medical Coding?
If you are a provider and are unsure about the differences in ICD-9 and ICD-10 codes or why there is a need for implementation, I highly suggest you read Tuesday’s post. More >
Are U.S. Providers Ready to Catch Up in Medical Coding?
After the bungled introduction of HealthCare.gov, providers are unquestionably leery of other technical health care-related requirements on the horizon. If there is a lesson to be learned in the wake of the Health Exchange debacle, it is this: it is never too early to prepare for change. More >
The Sun is Not Setting on the EHR Safe Harbor
The Centers for Medicare & Medicaid Services (“CMS”) and the U.S. Department of Health & Human Services Office of the Inspector General (“OIG”) recently announced that the regulation allowing certain health care entities to donate electronic health records (with the entity subsiding up to 85% of the donor’s costs) to physicians has been extended to December 31, 2021. The regulation, which provided a safe harbor from the Stark Law and Anti-kickback statute, was set to expire on December 31, 2013. More >
"Essential Benefits" Will Lead to More Patients for Some Providers
In a 2009 speech to the American Medical Association, President Obama promised, “If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.” This declaration came as the health care law was being written and similar statements were repeated by the President after the bill became law. More >
New Guidance for Skilled Nursing Facilities’ DNR and CPR Policies
Last year, a Registered Nurse working in an independent living facility refused to initiate CPR on an elderly resident who was experiencing respiratory distress, even as a 911 dispatcher begged her to do so. The 911 call was released, and the story made national headlines. Many condemned the nurse for her actions, but the nurse was simply following the facility’s no-CPR policy. More >
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 >
Top Ten Health Law Issues for Physicians, Health Systems and Providers in 2014
Change is the one constant that physicians, health systems and other providers face in 2014 as the ACA and its myriad regulations become effective along with increasing review and scrutiny from not just state and federal regulators, but also private companies with state and federal contracts to review and audit claims, cost reports, and billing practices. So, listed below are the top ten areas that physicians and other providers should watch in 2014. More >
The ACA’s Effect on Nonprofit Hospitals
By considering the promotion of health a charitable endeavor, the IRS has long granted nonprofit hospitals tax-exempt status under 501(c)(3), the charitable organization exemption. To maintain their status, nonprofit hospitals have always been required to meet specific requirements, such as having an independent board of trustees or offering preventive health outreach programs in their communities. More >
