News & Analysis as of

Centers for Medicare & Medicaid Services (CMS) Analytics

Sheppard Mullin Richter & Hampton LLP

The Intersection of Artificial Intelligence and Utilization Review

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the California Medical...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

King & Spalding

CMS Releases Medicaid and CHIP T-MSIS Analytic Files

King & Spalding on

CMS has been working with the states to improve Medicaid and CHIP data collection regarding beneficiaries, providers, fee-for-service claims, managed care claims and liable third parties. To improve the monitoring of these...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Enforcement Compliance Conference - November 3rd-6th, Washington , DC

Prepare your organization to respond to the ever-increasing emphasis on healthcare compliance issues by enforcement authorities. Hear first-hand from government officials about regulatory changes, expectations, and key...more

Dickinson Wright

Still Not Being Paid? Here Is Why and What Can Be Done! Eight New CPT Codes for Applied Behavioral Analytics Services Became...

Dickinson Wright on

The American Medical Association CPT Editorial Panel released eight standardized and permanent codes for billing applied behavioral analytics (ABA) therapy services that became effective January 1, 2019. ...more

Blank Rome LLP

The Government’s Use of Data Analytics to Identify Healthcare Fraud

Blank Rome LLP on

No one knows exactly how much fraudulent conduct costs the United States healthcare system. Some suggest it may cost Medicare, Medicaid, and private insurers $100 billion each year. Regardless of the exact amount, everyone...more

Hogan Lovells

Measures of success: How value-based pricing may change the pharmaceutical industry

Hogan Lovells on

Hogan Lovells partner Alice Valder Curran teams up with Robert Spurr of Novartis to outline the challenges and share potential solutions to consider when entering into value-based pricing arrangements. Adoption of...more

Foley & Lardner LLP

At The Intersection of New Bundled Payment Programs and New Discharge Rules: Private Equity Opportunities

Foley & Lardner LLP on

Recently, CMS has promulgated new bundled payment rules for Comprehensive Joint Replacement(CJR) that require the mandatory participation of approximately 800 hospitals across the US. This bundle includes not only the...more

King & Spalding

OIG Report Finds CMS’s MIDAS System Needs Improvement in Information Security Controls

King & Spalding on

On September 14, 2015, the OIG released a Public Summary Report finding that although CMS had implemented controls to secure the Multidimensional Insurance Data Analytics System (MIDAS) and consumer personally identifiable...more

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