From Report on Medicare Compliance - You wouldn’t think the word “arrangement” could lord it over the word “agreement,” but apparently that’s the case when it comes to Stark compliance, according to changes implemented in the 2016 Medicare physician fee schedule regulation, which took effect Jan. 1. If hospitals reconsider the way they approach arrangements with referring physicians and act accordingly, they may be able to sidestep some of the Stark minefields that were so easy to explode before the clarifications, modifications and new exceptions came to life in the new regulation (RMC 11/9/15, p. 1; 7/20/15, p. 1). Read more
From The AIS Report on Blue Cross and Blue Shield Plans - Blues plan operator Anthem, Inc. finished 2015 with 38.6 million members — 1.1 million more than it had at the end of 2014 — the company said Jan. 27 when it reported fourth-quarter earnings. Sustained growth in Anthem’s Medicaid managed care business more than offset larger-than-expected losses in the company’s individual insurance unit. Read more
From AIS's Value-Based Care News - The Medicare Shared Savings Program (MSSP) added 100 new accountable care organizations as of Jan. 1 and saw nearly 150 ACOs out of 220 renew their expiring contracts for another three-year term. Including the class of 2016, CMS will have 434 ACOs participating in the MSSP, serving more than 7.7 million beneficiaries. CMS’s announcement means that the worst-case scenario of widespread dropouts from MSSP didn’t come to pass. Read more
From Medicare Advantage News - All of the signals — as well as the timing of the elections cycle — point to one thing about Medicare Advantage plan regulation this year. As Bruce Merlin Fried, managing partner in the Washington, D.C., office of the Dentons law firm, puts it, “We’re going to see a heightened level of audit and regulatory scrutiny and enforcement in 2016.” He notes that CMS has been “ramping up oversight and… Read more
From Drug Benefit News - While the workers’ compensation industry is working to tackle opioid misuse and abuse by effecting change at the state level (see story, p. 1), the Centers for Disease Control and Prevention (CDC) has posted a long-awaited set of prescribing guidelines that address, among other things, the use of opioids for chronic pain outside end-of-life care and opioid selection and dosage. Read more
From Report on Patient Privacy - If patients treated at Lakewood Regional Medical Center in Lakewood, Calif., want a copy of their medical record, they must physically go to the hospital to complete a request form. But, according to new guidance issued by the HHS Office for Civil Rights (OCR), this practice is an example of “unreasonable measures” that are forbidden under the privacy rule at 45 CFR §164.524, “Individuals’ Right under HIPAA to Access Their Health… Read more
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