Category:

Health Insurance

Removing “Incident to” Billing: Recommendations from Policy Experts

Earlier this year, the Medicare Payment Advisory Commission (MedPAC) uninamously voted to recommend removing “incident to” Medicare billing for advanced practice registered nurses (APRNs) and physician assistants (PAs). MedPAC serves as an independent congressional agency that advises Congress on Medicare-related issues by analyzing access and quality of care. If this recommendation is adopted, APRNs and PAs would only be able to bill Medicare directly, thus reducing the amount paid by Medicare from 100% under services billed “incident to” to 85% directly. This recommendation could potentially save the Medicare program up to $250 million annually and would allow for better data collection into the amount of services performed by APRNs and PAs, whose services are often masked under “incident to” billing reports. Though there is still some debate on whether the financial loss of losing this option is too high for primary physicians who may hire APRNs and PAs for their practice, the benefits of billing directly likely outweigh the losses.

Protecting PHI as the Health Care Industry Promotes Shift to TeleMedicine

In a time where much of the healthcare industry has shifted to incorporate telehealth and telemedicine, health care organizations and providers are faced with the upkeep of the growing influx of patient data and the challenges associated with their obligation to maintain patient privacy. These challenges increasingly more burdensome as providers strive to keep up to date with the advancement of technology. Healthcare organizations must maintain patient privacythrough close monitoring of clouds, employee use of mobile devices, patient access to medical information and scheduling, and access to the provider networks through non-organizational devices. Maintaining the multiple platforms is costly and the industry remains at risk due to the rising volumes of cybersecurity attacks and breaches. UConn Health recently experienced a data breachthat necessitated notifying 326,000 people of potential impact to their protected health information (PHI) including names, dates of birth, address, billing information, and even social security numbers due to potential access by an unauthorized person.

Injunctions Halt Trump Administration’s Attempt to Expand Religious Exemption for Obamacare Contraceptive Mandate

A pair of injunctions in the Northern District of California on January 13, and the Eastern District of Pennsylvania on January 14, halted the implementation of amendments to a religious exemption to the so-called contraception “mandate” of the Affordable Care Act, also known as Obamacare. The “mandate” requires most employers to include contraception coverage in the insurance plans they offer to employees. While Obama administrative agencies contemplated religious exemptions early on, contentious litigation and political transition expanded the scope of the exemption until these latest developments.

Illinois Law Makers Seeking to Curb E-Cigarette Use Among Teens and Children

In the wake of rising e-cigarette use among teens and children, Illinois lawmakers seek a legal solution to protect Illinois youths from smoking-related illnesses and pre-mature death. Illinois’s Congress introduced Tobacco 21, a bill designed to raise the legal age to purchase tobacco products like e-cigarettes to 21 years of age. Despite a lack of support from Governor Bruce Rauner, Illinois politicians continue to fight to save the bill, and with good reason. The United States Food and Drug Administration (FDA) recently announced its Youth Tobacco Prevention Plan, which addresses the rising e-cigarette use among adolescents. The FDA’s plan is two-fold: (1) crack down on the sale and marketing of e-cigarettes and (2) educate teens and children about the dangers of using e-cigarettes. Tobacco 21 provides support for the FDA’s Plan.

Proposed Public Charge Intended for Immigrants but will Impose on Health Care

Every time we turn on the news, someone is either talking about immigration reform or health care reform. Health care and immigration are two major areas that President Trump promised to address and is attempting to tackle within his first two years in office. Although most would not consider that these two issues would overlap, in today’s American health care system, Americans need immigrants. Immigrants contribute a great deal to our medical research, make up a large percentage of our health care providers, and subsidize health insurance premiums.

Is the ACA Unconstitutional (Again)?

Before the Affordable Care Act (“ACA”) was passed, critics exclaimed that the government had no right to interfere in a citizen’s healthcare. When it was passed, the requirement that every American purchase health insurance caused America to scramble to comply. However, in a year all the critics might be silenced. Recently, Congress repealed the individual mandate’s tax penalty. How will Americans comply with the new act?

Can Congress Regulate Big Pharma?

Drug companies need to fund the research and development necessary to create better products. This means that pharmaceutical companies have fought for years to maintain control over the prices of said drugs. But this standard is being challenged with a new bill that was introduced to the House of Representatives on June 25, 2018.

Market Giants Move to Redesign Healthcare

In January 2018, Warren Buffet, Jamie Dimon, and Jeff Bezos announced that Berkshire Hathaway, JP Morgan Chase, and Amazon would partner together to form a non-profit company aimed at improving the United State healthcare system and combating ever-increasing costs. The idea for the project came about from the ongoing discussion between the three CEOs regarding providing healthcare for their, collectively, approximately 840,000 employees. Even though details are scarce, given the importance of the issue and the prominent names attached to this project, the press, the public, and the market have reacted accordingly. In other words, people are scrambling to figure out what this might mean for their companies and our healthcare system as a whole.

An Overview of Illinois Public Act 100-0538 Compliance with the Hyde Amendment

Illinois Public Act 100-0538, commonly referred to as House Bill 40, was signed into law on September 28, 2017. The Act repeals provisions in existing Illinois laws that aim to make abortion illegal should there be any change to the federal standard. Additionally, the Act lifts a ban on insurance coverage for abortions for low-income individuals enrolled in Medicaid. While enacting House Bill 40 was a win for advocates of reproductive rights in Illinois, the state will still need to comply with federal anti-abortion laws, such as the Hyde Amendment.

Current Trends in Medicaid 1115 Waiver Requests: Are They Schemes to Avoid Compliance with Disfavored Requirements?

States looking for flexibility or creativity in implementing Medicaid programs can apply for waivers from the Secretary of Health and Human Services (HHS). According to the Medicaid and CHIP Payment Access Commission (MACPAC), waiver use is quite extensive—resulting in “wide variations in program design, covered services, and eligible populations among states and even within states.” As of September 2017, 33 states account for 41 approved waivers, and 18 states have 21 total pending waivers. The scope of these waivers traditionally broadens eligibility and creates new programs in states where Medicaid needs are not expressly recognized by federal law. Current pending applications suggest, however, that states seeking waivers now do so as a means to circumvent Medicaid program requirements they disagree with.