SZD Health Law Strategist: reform's impact on payment and delivery; hospital hit with lawsuit after complying with grand jury


Health care reform’s impact on payment and delivery models

Health care reform continues the shift away from the fee-for-service payment model toward models that reward coordinated, quality care. The Patient Protection and Affordable Care Act (the Act) includes a series of voluntary pilot programs to explore options for controlling costs while increasing quality.

Hospital hit with lawsuit after complying with grand jury subpoena

On Feb. 1, the U.S. District Court in Cleveland issued a significant decision concerning the disclosure of medical information in response to a grand jury subpoena.

New timely filing requirements for Medicare fee-for-service claims

Section 6404 of the Patient Protection and Affordable Care Act (the Act) amended the timely filing requirements to reduce the maximum time period for submission of all Medicare fee-for-service claims to one calendar year after the date of service.

Medical homes improve primary care delivery

Medical homes have emerged as a leading model for improving the quality and accessibility of health care. A medical home is not a physical location, but rather it is a comprehensive approach to primary care that emphasizes coordination of care and fosters a more collaborative physician-patient relationship.

Health care reform enhances fraud and abuse laws

The Patient Protection and Affordable Care Act includes new fraud and abuse provisions.

64 percent of appealed RAC claims decided for providers

According to a recently released report from Centers for Medicare & Medicaid Services (CMS), providers won 64.4 percent of appealed claims during the three-year Recovery Audit Contractors (RAC) demonstration project. Providers appealed 76,000 claims and received favorable decisions on 49,000.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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