News & Analysis as of

Clinically Integrated Networks Give Providers and Payers an Opportunity for Transformative Collaboration

I. Executive Summary - The health care sector is experiencing a series of market reforms that have the potential to reshape how care will be delivered and reimbursed for decades to come. Although a number of concepts...more

CMS Instructs Contractors Not to Conduct Patient Status Reviews for Claims with Dates of Admission Through December 31, 2013

On November 15, 2013, CMS issued Transmittal 1315, a One-Time Notification (CMS Transmittal), instructing Medicare Administrative Contractors (MACs), Recovery Auditors and the Supplemental Medical Review Contractor not to...more

HFMA Releases Provider-Patient Financial Communications Best Practices

Healthcare financial interactions are often complex and confusing for patients and can involve complicated payment structures and various “key players.” As patients become responsible for greater proportions of their...more

Terminating The Physician-Patient Relationship

Oftentimes, I am asked by physicians how to end the physician-patient relationship. For various reasons, the physician desires to end the relationship and have the parties go their separate ways. Such may stem from a...more

OIG rejects management arrangement that carves out federal healthcare program patients

The Office of Inspector General of the Department of Health and Human Services recently posted an Advisory Opinion describing a proposed arrangement by a clinical laboratory. ...more

CMS Releases FY 2014 Hospital IPPS Final Rule

On August 2, 2013, CMS released the annual Hospital Inpatient Prospective Payment System Final Rule for FY 2014 (the “Final Rule”), effective for discharges occurring on or after October 1, 2013....more

Getting the Best Medical Care: a Newsletter from Patrick Malone - August 2013

In This Issue: - Everyone Has an Agenda - How Executive Pay Skews Some Rankings - Learn More From These Resources - Excerpt: The Dicey Connection between Hospital Ratings and Superior Patient...more

Healthcare Update, No. 3, August 2013: Protect Your Key Information – And Your Key Relationships

Decades ago, it was reasonable to imagine that one could work for the same company from the start of one’s career to the end. Think about the world portrayed in Mad Men. Don Draper has mostly worked with the same fictional...more

Expanding Access to, and Development of, Personalized Medicine

In a July 8th, 2013 letter to the Centers for Medicare & Medicaid Services (CMS), the Personalized Medicine Coalition (PMC) advised that proposed reimbursement schedules for diagnostic medicine will threaten the development...more

Hospitals Fight Back to Defend 340B Program Operations

Adhering to the axiom that the best defense is a good offense, SNHPA (Safety Net Hospitals for Pharmaceutical Access), an organization of close to 1000 hospitals participating in the 340B Drug Pricing Program, is attempting...more

CMS Issues Proposed Rule Updating ESRD PPS for CY 2014

CMS recently issued a proposed rule detailing updates and revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014 and requirements for the ESRD quality incentive program...more

Getting the Best Medical Care: a Newsletter from Patrick Malone - May 2013

In This Issue: - When Hospital Errors Follow You Home, and Into Your Soul - What Survivors of Patient Harm Can Expect - Hurting the Healing Process - Learn More About Your Rights and How to Reduce the Harms of...more

CMS Issues Proposed Changes to LTCH Payment Rates and Other Payment Policies for Fiscal Year 2014

On April 26, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed update to the Medicare long-term acute care hospital prospective payment system (“LTCH PPS”) policies and payment rates for fiscal...more

Getting the Best Medical Care: a Newsletter from Patrick Malone - February 2013

In This Issue: - What Is a Nurse Practitioner? - An Expanding Role - The Money Issue - Bottom Line: Focus on the Patient - Recent Health CareNews You ShouldKnow About - Check Out Our Previous Tips -...more

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