New Era of Healthcare Fraud Investigations Focuses On Individual Accountability

Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017   Traditionally, only healthcare corporations were held responsible for healthcare fraud. During an investigation, these corporations were only required to provide contextual information about the underlying factual situation in a fraud investigation. Additionally, healthcare corporations would typically enter into settlement agreements with the …
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How Communications Play a Key Role in the Hospital Readmissions Reduction

Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017   CMS has reported that Medicare expenditures amount to roughly 17 billion a year on patient readmissions alone. Studies show that almost twenty percent of all patients who are admitted to a U.S. hospital makes a repeat visit within thirty days of discharge. …
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MACRA 101: Advanced Alternative Payment Models

Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018   The Quality Payment Program (QPP) will reward delivery of quality patient care through the following two programs: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). These two programs will allow clinicians and physicians to provide care in a …
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MACRA 101: MIPS and the Clinical Practice Improvement Reporting Category

Christine Bulgozdi Associate Editor Loyola University Chicago School of Law, JD 2018   The Merit-based Incentive Payment System (“MIPS”) is one of the two different payment methods that MACRA will use for eligible clinicians. Clinicians will be evaluated based on a single Composite Performance Score from four reporting categories: Quality, Resource Use, Advancing Care Information and …
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MACRA 101: MIPS and the Advancing Care Information Category

Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017   This article will spell out the details for the Advancing Care Information (ACI) category of the Merit Based Incentive Payment System (MIPS).  This category accounts for 25% of a clinician’s overall composite score and is intended to replace the current Meaningful Use …
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MACRA 101: MIPS and the Resource Use Category

Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018   As previously discussed, MIPS will streamline Medicare’s current quality measures into one composite score from four reporting categories: Quality, Resource Use, Advancing Care Information, and Clinical Practice Improvement. This score will then be used to determine the reimbursement to a clinician based …
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MACRA 101: MIPS and the Quality Reporting Category

Christine Bulgozdi Associate Editor Loyola University Chicago School of Law, JD 2018   The Merit-based Incentive Payment System (“MIPS”) is one of the two different payment methods that MACRA will use for eligible clinicians. MIPS replaces the existing fee-for-service model and is expected to be the payment track that most clinicians take. Clinicians will be evaluated …
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Understanding Medicare Documentation Requirements

Brittany Tomkies Executive Editor Loyola University Chicago School of Law, JD 2017   With more than one billion claims processed annually by the Medicare Fee-For Service (FFS) Program for more than one million health care professionals, understanding and identifying common errors encountered by Medicare Administrative Contractors (MACs) and other contractors such as Recovery Auditors (RACs) …
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Compliance During the Holidays: Following Regulations on Employer Anti-Discrimination

Melody Saveall Senior Editor Loyola University Chicago School of Law, JD 2018   With Halloween already past and the holiday season just ahead, it is important to remember the Equal Employment Opportunity Commission’s guidances on respecting employees’ religious beliefs, and reasonably accommodating them. Title VII of the Civil Rights Act of 1964 governs these policies and …
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