Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. Characteristics of Prior Authorization Policies for New Drugs in Medicare Part D. 2023 Feb 23.

Medicare 144

Medicare Medicare Medicaid Medicaid 144

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 95

Fraud Medicaid Medicaid Doctors 95

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Providers also need an NPI to enroll in Medicare.

Fraud 97

Fraud HIPAA Medicare Medicare 97

AIHC

NOVEMBER 29, 2023

Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. MA/HMO) is typically used by Health Maintenance Organizations and Medicare Advantage Organizations. healthcare system were exorbitant. Capitation (e.g.,

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Hall Render

JULY 1, 2022

the Supreme Court upheld CMS’s decision to include Medicare exhaust and secondary payor days in the Medicare Fraction of the Disproportionate Share Hospital (“DSH”) statute. The DSH statute instructs CMS to include in the Medicare Fraction’s denominator all patients “entitled to benefits” under Medicare Part A.

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

AIHC

NOVEMBER 29, 2023

Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. MA/HMO) is typically used by Health Maintenance Organizations and Medicare Advantage Organizations. healthcare system were exorbitant. Capitation (e.g.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Verisys

FEBRUARY 1, 2022

Providers also need an NPI prior to enrolling in Medicare. In July 1993, the Centers for Medicare and Medicaid Services ( CMS ) undertook a project to develop a healthcare provider identification system to meet the needs of the Medicare and Medicaid programs and the needs of a national identification system for all providers.

Fraud 52

Fraud Medicare Medicare HIPAA 52