http://faegrebdc.com/reimbursement en-us Copyright 2000-16 FaegreBD Consulting. All Rights Reserved. http://blogs.law.harvard.edu/tech/rss 11/27/2016 8:32:33 AM On November 14, 2016, the Centers for Medicare and Medicaid Services (CMS) published the 2017 Outpatient Prospective Payment System (OPPS) final rule in the Federal Register. The rule finalizes changes to the Electronic Health Record (EHR) Incentive... http://faegrebdc.com/meaningful-use-changes-in-2017-opps-final-rule 15 Nov 2016 00:00:00:000 Formal complaints were recently filed with the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) regarding alleged discrimination against HIV patients in individual market health plans. Filed by the Center for Health Law... http://faegrebdc.com/when-is-an-insurance-benefit-discriminatory-landmark-complaint-seeks-to 20 Oct 2016 00:00:00:000 David Brooks, an op-ed columnist for the The New York Times, used a quote from FaegreBD Consulting Senior Director Mike Adelberg from a Vox article where he discussed the shrinking Affordable Care Act (ACA) marketplace and its resemblance to similar... http://faegrebdc.com/the-new-york-times-picks-up-quotes-from-mike-adelberg 07 Sep 2016 00:00:00:000 The federal government recently blocked insurance giant, Aetna, from acquiring Humana which may have contributed to Aetna's decision to drop 70 percent of its health plans in the Affordable Care Act (ACA) markets. Amid continued losses, Aetna and... http://faegrebdc.com/mike-adelberg-quoted-in-modern-healthcare-about-aca-risk-adjustment 23 Aug 2016 00:00:00:000 FaegreBD Consulting Senior Director Mike Adelberg contributed several quotes to a recent edition of Medicare Advantage News where he discussed two different topics surrounding changes in the Medicare marketplace. In one article, Adelberg shared... http://faegrebdc.com/mike-adelberg-quoted-in-medicare-advantage-news-about-cms-secret 22 Aug 2016 00:00:00:000 In a recent Health Affairs Blog essay with professor Nicholas Bagley of the University of Michigan law school, FaegreBD Consulting Senior Director Mike Adelberg broke down the premium stabilization programs of the Affordable Care Act (ACA) that... http://faegrebdc.com/la-times-and-politico-pick-up-mike-adelbergs-affordable-care 10 Aug 2016 00:00:00:000 CMS has implemented a new policy where Medicare Advantage plans’ entire provider networks undergo review when requesting service area expansions. As Mike Adelberg, senior director for FaegreBD Consulting, explained in Medicare Advantage News, this... http://faegrebdc.com/mike-adelberg-discusses-cmss-new-network-review-policy-in-medicare 09 Aug 2016 00:00:00:000 ​Medicare Advantage (MA) organizations may want to plan for a future in which they are required by the Centers for Medicare and Medicaid Services’ to hire independent auditors to confirm that they have remediated agency concerns. As Mike Adelberg... http://faegrebdc.com/mike-adelberg-discusses-medicare-advantage-audits-network-adequacy-in-medicare 15 Jul 2016 00:00:00:000 Less than a third of health plan members in California are able to schedule an appointment with their preferred physician, according to a study published in Health Affairs on July 6, 2016. The study, completed by researchers at University of... http://faegrebdc.com/when-a-good-doc-is-hard-to-find-study-suggests 08 Jul 2016 00:00:00:000 On June 20, 2016, The Kaiser Family Foundation issued the first ever broad-based study of Medicare Advantage hospital networks. The study — "Medicare Advantage Hospital Networks: How Much Do They Vary?"— analyzed 409 plans in 20 counties across the... http://faegrebdc.com/broad-examination-of-narrow-networks-first-of-its-kind-study 22 Jun 2016 00:00:00:000 On June 10, 2016, the Centers for Medicare and Medicaid Services (CMS) released updated Marketing Guidelines that dictate how Medicare Advantage and Part D products can be described and sold. While most of the 100+ pages of guidance remain the same... http://faegrebdc.com/no-game-changers-but-many-game-tweakers-the-new-medicare 15 Jun 2016 00:00:00:000 Samantha N. Strong has joined FaegreBD Consulting as an advisor with the health and biosciences team in Washington, D.C. Strong brings a strong focus on government advocacy. Grounded in pragmatic choices and political implications, she combines... http://faegrebdc.com/samantha-strong-brings-bioethics-background-to-faegrebd-consulting 31 May 2016 00:00:00:000 In early May 2016, the Government Accountability Office (GAO) released a critical report on the inability of the Centers for Medicare and Medicaid Services (CMS) to recover overcharges from errant and aggressive payment coding in the Medicare... http://faegrebdc.com/gao-roasts-cms-for-weak-risk-adjustment-oversight-medicare-advantage 16 May 2016 00:00:00:000 Kelly M. Nickel has joined FaegreBD Consulting as an advisor with the health and biosciences team in Washington, D.C. Nickel brings a range of experience in health care and advocacy circles. Her diverse background in today’s complex government... http://faegrebdc.com/kelly-nickel-brings-diverse-background-to-health-and-biosciences-team 20 Mar 2016 00:00:00:000 Following weeks of speculation and angst, including a false start posting on a Medicare contractor’s website earlier this winter, the Centers for Medicare & Medicaid Services (CMS) this week issued a controversial mandatory demonstration project... http://faegrebdc.com/cms-forges-ahead-with-controversial-part-b-drug-demo-mdash 14 Mar 2016 00:00:00:000 In its fourth annual draft annual letter to issuers, released at the end of 2015, the Centers for Medicare and Medicaid Services (CMS) indicated plans to take a more assertive regulatory hand in federally facilitated health exchanges (FFEs) in 2017... http://faegrebdc.com/mike-adelberg-cms-might-draw-criticism-for-increased-role-in 22 Jan 2016 00:00:00:000 During the holiday season lull, the Centers for Medicare and Medicaid Services (CMS) issued a weighty document. The agency put out a draft statement of work to procure Recovery Audit Contractors (RACs) for the Medicare Advantage risk adjustment... http://faegrebdc.com/whether-naughty-or-nice-recovery-audit-contractors-are-coming-to 04 Jan 2016 00:00:00:000 In late 2015, the Centers for Medicare and Medicaid Services (CMS) released two documents that together establish new directions for the Health Insurance Exchanges in 2017: the draft annual letter to issuers and the draft Notice of Benefit of... http://faegrebdc.com/this-annual-letter-is-not-like-the-others-cms-breaks 28 Dec 2015 00:00:00:000 On December 11, 2015, the Centers for Medicare and Medicaid Services (CMS) released long-awaited guidance on “1332 waivers” by which a state can waive certain health insurance exchange requirements as early as January 1, 2017. The guidance sets... http://faegrebdc.com/door-opens-a-little-for-exchange-changes-cms-releases-guidance 16 Dec 2015 00:00:00:000 On November 22, 2015, after more than a year of deliberations, the National Association of Insurance Commissioners (NAIC) approved a new model law for regulating health plan provider networks. The new model law, the first update in a generation... http://faegrebdc.com/exceptional-attention-on-adequacy-regulators-respond-to-narrow-network-health 24 Nov 2015 00:00:00:000 Bruce Quinn of FaegreBD Consulting will be the opening speaker at the Integrating Personalized Medicine Into Health Care Summit on October 14, 2015, at the Renaissance Hotel in Washington, D.C. His presentation will address “Meeting the Challenges... http://faegrebdc.com/integrating-personalized-medicine-into-health-care 14 Oct 2015 00:00:00:000 On August 11, 2015, the Centers for Medicare and Medicaid Services (CMS) posted for public comment notice of a new required data collection for health insurers. Its purpose is to begin the implementation of section 1311 of the Affordable Care Act... http://faegrebdc.com/a-first-step-on-a-long-road-cms-begins-implementation 18 Aug 2015 00:00:00:000 Bruce Quinn, M.D., Ph.D., has joined FaegreBD Consulting as a senior director with the firm’s health and biosciences team in Washington, D.C., where he leads the firm’s health markets and reimbursement strategy consulting practice. He has offices in... http://faegrebdc.com/health-markets-reimbursement-policy-expert-bruce-quinn-md-phd-joins 20 Jul 2015 00:00:00:000 On June 25, 2015, the U.S. Supreme Court ruled in King v. Burwell that premium subsidies issued to limited-income consumers established by the Affordable Care Act (ACA) can continue flowing to consumers in the 34 federally run exchanges. The 6-3... http://faegrebdc.com/supreme-court-again-throws-the-aca-a-lifeline-but-storms 26 Jun 2015 00:00:00:000 This month, the U.S. Supreme Court is expected to rule on King v. Burwell, in which it will determine if the federally-run health insurance exchanges can continue offering tax credits and subsidies that make health insurance affordable to the 6.4... http://faegrebdc.com/the-affordable-care-acts-next-challenge 11 Jun 2015 00:00:00:000 On May 26, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed the most significant Medicaid regulation since the regulations following Welfare Reform in 1996. The overarching goal of this 653-page regulatory package is to create... http://faegrebdc.com/medicaids-big-leap-cms-releases-medicaid-managed-care-mega-reg 29 May 2015 00:00:00:000 On May 21, 2015, Covered California, the state’s health insurance exchange, became the first in the nation to cap a consumer’s monthly cost for a particular prescription. The $250 per-prescription limit will go into effect in January 2016 for the... http://faegrebdc.com/west-coast-watershed-the-california-exchange-caps-specialty-drug-costs 27 May 2015 00:00:00:000 On April 14, 2015, the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act (MACRA) that would fix a long-term problem in the Sustainable Growth Rate (SGR) methodology Medicare uses to pay physicians in Part B. Nicknamed “doc fix,”... http://faegrebdc.com/below-the-fold-new-medicare-law-includes-boosts-for-medicare 17 Apr 2015 00:00:00:000 On April 8, 2015, the Centers for Medicare and Medicaid Services (CMS) released a draft regulation that proposes to extend the mental health parity coverage requirements of the Mental Health Parity Act (1996) and the Mental Health Parity and... http://faegrebdc.com/mental-health-advocates-applaud-new-cms-regulation-extends-mental-health 10 Apr 2015 00:00:00:000 The U.S. Supreme Court is deliberating on King v. Burwell to determine if the Affordable Care Act permits the issuance of subsidies to defray the cost of insurance purchased through exchanges run mostly or entirely by the federal government, rather... http://faegrebdc.com/overview-of-potential-legislative-and-executive-options-to-respond-to 30 Mar 2015 00:00:00:000