Tag:Health Insurance
CMS Issues Proposed Rule Addressing Multiple Fraud and Abuse Concerns
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 The Centers for Medicare and Medicaid Services (CMS) recently proposed a new rule in the Federal Register that addresses changes in Medicare payment policies. The proposed rule aims to inform providers of proper billing practices and prevent fraud and abuse. This post …
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IRS Ruling Threatens Future of Commercial ACOs, Cost-Reducing Healthcare Providers
Connie Zhang Associate Editor Loyola University Chicago School of Law, JD 2018 Your healthcare may come from an accountable care organization, and you may not even know it. That could soon change now that the IRS has denied one commercial accountable care organization (ACO) the tax-exempt status granted to most nonprofit health care providers. …
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MACRA 101: Physician Fee Schedule Adjustments and the New Pick Your Pace Options
Alanna J. Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017 In this article, we will cover the anticipated reimbursement scheme for both MIPS and APMs, as well as briefly discuss two new reporting paths recently revealed to be available to clinicians in 2017. One of the most attractive pieces of the …
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MACRA 101: A Series on MACRA
Alanna J. Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017 The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law by President Obama back in April 2015 and one year later, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated proposed rule. This 962-page rule is …
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Insurance Plans and Opioids: Releasing and Raising the Barriers to Prescribe
With the opioid addiction epidemic continuing to rise in the United States, several insurance companies loosened the existing barriers to addiction treatment. Aetna Insurance Company joined Cigna and Anthem in removing key provisions in its insurance plans that require additional authorization prior to providing addiction treatment. At the same time, Cigna proposed to strengthen barriers to physician prescribing of opioids in an attempt to further address the opioid epidemic.
MACRA 101: Noteworthy Changes in the Final Rule
Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017 As our MACRA 101 series comes to an end, this article is intended to point out key differences between the proposed rule released earlier this year and the final rule which was released October 14th. The lengthy final rule, reaching almost 2,400 …
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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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