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March 30, 2015

Today's Featured Story

Medicare Billing Revocations Surge as CMS Flexes Enrollment Muscle; Appeals Are Little Help
Reprinted from Report on Medicare Compliance

CMS is stripping more providers of their Medicare billing privileges, sometimes using new grounds from a Dec. 5 regulation, attorneys say. The revocation of billing privileges is so threatening to providers since, obviously, they can’t bill for services while their privileges have been withdrawn, which continues through their appeal. If the revocation hits practitioners, they also can’t order or provide services at hospitals and their ability to fight back has its limits. This is apparently by design, as CMS redoubles its campaign to separate from Medicare what it sees as undesirable providers. But lawyers are worried about the intensifying use of revocations, and question whether CMS is going overboard.... Read Full Story


From the AIS Blogs

Commercial ACOs Could Look to Medicaid for Behavioral Health Models

Many accountable care organizations (ACOs) focus on the low-hanging fruit first, tackling areas like readmissions, post-acute care and out-of-network referrals. But ACOs that hold contracts with Medicare or commercial payers may want to take a look at the Medicaid program for strategies for integrating behavioral health care into their systems.... Read more


Quote of the Day

“Generic inflation is interesting because it’s not generally across the board. It’s in some drugs and they’re at the maximum allowable cost, so capping what the pharmacies can charge for some products helps to some extent, as does the use of home delivery to secure even better discounts.”

— Glen Stettin, M.D., senior VP for clinical, research and new solutions at Express Scripts Holding Co., who was interviewed by AIS’s Drug Benefit News about his firm’s new Drug Trend Report.



Today's Datapoint

25% ... of new enrollees in Illinois’ federally run exchange opted for the Consumer Operated and Oriented Plan (COO-OP) Land of Lincoln Health during the recently concluded open-enrollment period.

Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. (Free for HEX subscribers; $17 for non-subscribers).


Today from Washington

People on the Move

Nova Southeastern University appointed Kelly Gregg vice president for clinical operations. Gregg was previously chief financial officer and senior manager for Diagnostic Clinic Medical Group....Sagent Pharmaceuticals, Inc. Chairman and CEO Jeffrey Yordon is retiring. He will remain a member of the board, and Frank Kung, Ph.D., has been named as his replacement....The Alliance of Community Health Plans President and CEO Patricia Smith announced she is retiring at the end of the year. She has held the position since 2006....CCS Medical named Rodney Carson president and CEO. Carson was formerly president of MDLIVE.


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