Health Insurance Medicare

News & Analysis as of

Could Possible Healthcare Repeal Efforts Extend to Physician Payments Under Medicare?

Now that the 2016 presidential election is over, many patients are asking whether Congress will repeal the Affordable Care Act (ACA), or parts of the legislation. Yet, many doctors are asking (or should be asking) whether...more

Be wary of counterfactual assertions about Obamacare, Medicare, Medicaid

As speculation explodes about what the GOP and the president-elect will or won’t do with the Affordable Health Care Act (aka Obamacare), Medicare, and Medicaid, skeptical citizens would be well-served to learn as much as they...more

Replacing The Affordable Care Act: A Reality Infusion

During the course of his campaign, President-elect Donald Trump repeatedly promised to repeal and replace President Obama's signature legislation, the Affordable Care Act (ACA). Certainly the Republican Party's continuing...more

Will Employers’ ACA Obligations Change Under the Trump Administration?

During his campaign, President-elect Trump promised to make the repeal and replacement of the Affordable Care Act (ACA) a priority. Now that the election is over, what should employers expect? We don’t have a crystal ball,...more

CMS Continues Efforts to Improve Patient Care, Spending, and Population Health

On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS), released the 2017 Medicare Physician Fee Schedule (MPFS) final rule, which finalized a number of new policies designed to improve Medicare payment for...more

The New Political Landscape’s Impact on Health Care Investing: 10 Takeaways from the Epstein Becker Green and Jefferies...

The day after the 2016 U.S. presidential election, Epstein Becker Green, in conjunction with Jefferies LLC, hosted “The Ballots Are Counted: How the New Political Landscape Will Shape Health Care Investing.” The event was...more

2017 OPPS Final Rule: Payment to Off-Campus Provider-Based Departments

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the 2017 Medicare Outpatient Prospective Payment System (OPPS) Final Rule. One aspect of this rule is the implementation of payment decreases for...more

“May You Live in Interesting Times” – Some Healthcare Predictions for the Trump Administration’s First Year

The ancient Chinese curse – “May you live in interesting times” – certainly springs to mind these days. What does the election of Donald Trump mean for the healthcare industry, the Affordable Care Act and current healthcare...more

The Road to Higher Out-of-Pocket Medical Costs is Paved with Good Intentions: The Unintended Consequences of High Deductible...

High-deductible health plans (HDHPs) are among the fastest growing health plans in both the individual and group markets. For calendar year 2017, the IRS defines an HDHP as any health plan with a minimum deductible of $1300...more

California Clamps Down On Surprise Out-Of-Network Bills

On September 23, 2016, Governor Brown signed AB 72, California’s surprise out-of-network law. The bill protects patients who seek care at an in-network facility from balance billing by individual health care providers who are...more

California Targets Surprise Medical Bills, Follows on the Heels of New York and Florida

Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills. AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers...more

Medicare Coverage While Traveling Within the U.S.

When people retire they often have more time to travel. Although Medicare coverage is generally not available when beneficiaries are overseas, what about coverage for those exploring our own varied and scenic land?...more

Health Alert (Australia) September 12, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Queensland - 2 September 2016 - Inquest into the death of Michael James Calder Mr Calder was aged 33 when he was...more

Eleventh Circuit Finds Insurer Liable for Medicare Lien Notwithstanding Insurer's Efforts to Satisfy the Lien in Settlement, also...

In a case with far-reaching implications, the Eleventh Circuit Court of Appeals issued an opinion concluding that the Medicare Secondary Payer Act (MSP) permits a private insurance company/PART C Medicare Advantage...more

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

New Study Finds Medicare Advantage Plans Pay Lower Prices Than Traditional Medicare

A new study by Stanford University researchers finds that Medicare Advantage plans pay lower prices than traditional fee-for-service (FFS) Medicare for most types of hospital admissions. According to the study—published...more

Medicare Advantage Organizations May Sue For Double Damages Under MSP Act - Humana Medical Plan, Inc. v. Western Heritage Ins....

On August 8, the Eleventh Circuit Court of Appeals decided an issue of first impression in the circuit under the Medicare Secondary Payer (MSP) Act. In sum, the Eleventh Circuit held that a Medicare Advantage Organization...more

Game-Changing PAMA Rule Sets off Major Payment Shifts for Lab Tests

The Centers for Medicare & Medicaid Services (CMS) recently published a major final rule that will base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts, as required by the...more

HHS Final Rule Extends Anti-Discrimination Protection to Transgender Patients

This past May, the Department of Health and Human Services (HHS) issued a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin,...more

Health Update - July 2016

The Vulnerability of Healthcare Information - According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more

Florida DCAs Weigh in on Allstate Case; PIP Litigation Now Headed to Supreme Court

The Florida Supreme Court soon will hear arguments in the case of Florida Wellness & Rehabilitation vs. Allstate Fire & Casualty Insurance Co., which pits medical providers against the automobile insurer on the issue of fees...more

CMS Issues Medicare Physician Fee Schedule Proposed Rule

On July 7, 2016, CMS issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017 (Proposed...more

ColoradoCare Stands to Significantly Alter Health Care Services

In November, Colorado voters will cast ballots on Amendment 69, also known as ColoradoCare. ColoradoCare is an ambitious, far-reaching plan to amend the Colorado constitution which would establish a statewide universal...more

HHS Issues Final Rule on ACA Nondiscrimination in Health Programs and Activities

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations interpreting the nondiscrimination provisions of Section 1557 of the Affordable Care Act (“ACA”). The rule mainly impacts insurers...more

IRS Denial of Section 501(c)(3) Status for a Commercial ACO

The IRS recently released a ruling, Private Letter Ruling (“PLR”) 201615022, denying Section 501(c)(3) tax-exempt status to a “commercial” accountable care organization (“ACO”). This is the IRS’ first published guidance...more

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