Shortly after Memorial Day 2018, the federal government announced its plan to bring back a payment review project that puts significant administrative burdens on home health agencies. Originally called the Pre-Claim Review Demonstration for Home Health Services, the project has been rebranded as the Review Choice Demonstration for Home Health Services. The original project’s rollout in Illinois resulted in extensive issues, reported delays in access to care, and even some home health agencies going out of business.Read More
A federal appeals court issued a significant ruling last week in relation to the ongoing backlog of Medicare claims appeals. It potentially gives providers a new way to seek relief when Medicare comes to collect money that an administrative law judge has yet to rule is actually owed.
This is not a theoretical concern: Many providers have gone out of business because they could not afford to pay the government or have their money suspended while their appeal was tied up in the backlog. The backlog has become a critical issue for hospitals, physician practices, home health agencies, hospices, nursing homes, and other providers all across the country.Read More
The North Carolina Department of Health and Human Services recently laid out a road map for improving behavioral health services in the state. The report to the state legislature was the result of numerous stakeholder meetings and six listening sessions across North Carolina. In fact, it goes beyond mental health: The Department of Health and Human Services (DHHS) stresses the importance of breaking down silos to deliver “whole-person care.”Read More
The Trump administration is putting the brakes on a payment model that gained steam across the health care industry under the Obama administration.Read More
The federal government recently awarded new contracts for Medicare recovery audits, and recovery audit contractors (RACs) will start showing up at hospitals, home health providers, and other facilities any time. But this latest round of audits for Medicare overpayments almost didn’t happen.Read More
With low unemployment rates in the Carolinas, many companies – including health care providers – are looking to their competitors to find qualified employees. This hiring strategy has led to a surge in litigation over employee noncompetition and related restrictive covenants. Over the past decade, North Carolina and South Carolina courts have dramatically changed their views on enforceable employment restrictions, meaning that many older agreements may no longer be enforceable.Read More
We both recently returned from presenting to groups of health care providers on creating and implementing effective compliance programs. Although compliance plans and compliance programs are not new to the health care realm, their importance cannot be understated. Accrediting bodies, payers, auditors and investigating entities expect for providers to have compliance plans in place – and expect them to be followed. Here are a few key points about turning a policy into an effective compliance plan:Read More
Medicaid expansion has already had a huge impact on whether mental health needs are treated in certain populations. That may not be at the top of all the stories lately about the U.S. House of Representatives passing its replacement of the Affordable Care Act and the Senate considering its own version. But it is a significant piece of our country’s behavioral health puzzle. The expansion brought coverage to many low-income adults without children, a group that had largely been left out of Medicaid programs.
On February 21, Patti Bartis of Parker Poe highlighted the significant employment law issues facing medical practices on a webinar hosted by the North Carolina Medical Society Foundation in cooperation with the North Carolina Medical Group Management Association.
While much of the attention related to health care this week is focused on our nation’s capital, all 50 state governors have received a letter from recently confirmed U.S. Health & Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma. The letter begins by noting the challenges facing Medicaid. The authors describe Medicaid expansion as “a clear departure from the core, historical mission of the program” and as creating “an incentive to deprioritize the most vulnerable populations.” The letter then commits to working with expansion states (31 plus the District of Columbia) and non-expansion states (19) on a “solution that best uses taxpayer dollars to serve the truly vulnerable.”