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Budget Neutrality Policy

Marshall Dennehey

County Court Rules in Favor of Plaintiff Regarding Defendant’s Use of Budget Neutrality Adjustor in Calculating Reimbursement Made...

Marshall Dennehey on

ISO Diagnostic Testing Inc. v. United Automobile Ins. Co., Broward County Case No: COINX-22-024098 - This suit was for allegedly underpaid PIP benefits. ISO Diagnostic Testing billed seven units of CPT code 95851. United Auto...more

Mintz - Health Care Viewpoints

Did the Tenth Circuit Just Put the Final Nail in the Coffin for Challenges to the Use of “Statewide Average Premium” in Risk...

On December 31, 2019, the Tenth Circuit Court of Appeals upheld the Department of Health & Human Services’ Affordable Care Act (ACA) risk adjustment methodology in New Mexico Health Connections v. HHS, No. 18-2186 (10th Cir....more

Baker Donelson

D.C. Court Rejects CMS's 2018 "Budget Neutrality" Policy

Baker Donelson on

In a September 17, 2019 decision, the United States District Court for the District of Columbia invalidated a CMS rule expanding site-neutral payment reductions to evaluation and management (E&M) services furnished in...more

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