By Robin Fisk for health care providers, practitioners, insurers and managed care companies to address issues that arise in the relationship between them.
Marla Durben Hirsch is a health lawyer, editor of the American Bar Association's Health Lawyer publication and an author in her own right. Fierce Practice Management just published an e-book that she helped author entitled "Dollars Make Sense: Proven Strategies to Increase Medical Practice Revenue". In writing this book, she has called on a few folks for input, including yours truly. It has some great ideas and advice, but as always, some ideas will comply with the laws in one state, but not in another so please discuss them with your attorney before implementing them.
You can download the e-book free from FiercePracticeManagement.com here: Dollars Make Sense
On Friday, March 2nd, the judge hearing the case brought by ten New Hampshire hospitals against New Hampshire’s Medicaid Program, issued an order requiring the Commissioner of the New Hampshire Department of Health and Human Services (“NHDHHS”) to begin public hearings on the current Medicaid rates. This order will likely be the first of many shoes to drop.
Here is an article that I wrote with Leah Stewart of Beatty, Bangle & Strama, PC of Austin, Texas. It was published by the American Bar Association's Health Lawyer, so has an understandably legal slant. It gives an overview of the Consumer Operated and Oriented Health Plan Program to date. Since then, I've been up to my ears with filing applications on behalf of CO-OPs and working to get them formed.
As regular readers know, I have been working on developing Health Care Cooperatives (called "Consumer Operated and Oriented Plans" or "CO-OPs") under a program created by the federal health care reform law. The Robert Wood Johnson Foundation recently published an article by Bradford H. Gray, PhD. giving an overview and early assessment of the CO-OP Program. The article can be found HERE.
Several months ago, I posted an article describing the new federal minimum claim standards, including the availability of external appeals. These new standards were included in the PPACA and published as an interim final rule on July 23, 2010 (the "Interim Rule"). At the time, I referred to these rules as enhancing an important set of rights for enrollees and for providers assisting their patients with coverage disputes. For a more complete list of the changes required by the PPACA, see that earlier post, see link here.
On June 24th, 2011, amendments to the Interim Rule were published by HHS, the Department of Labor and the Treasury (the “Amendments”). These Amendments incorporate public comments received in the wake of the Interim Rule. Unfortunately they weaken claimant rights and delay or undermine many of the measures intended to simplify the appeal process. The changes affect expedited coverage determinations, the information included in notices of coverage determinations, rights to external appeal and the procedures governing external appeal.
On Monday, HHS issued its set of proposed rules for the Consumer Operated and Oriented Plan Program. I wrote about it earlier here and that article provides the context for the cryptic notes that follow. These same proposals appear in this morning’s Federal Register. Although I am still going through the rule, some initial notes:
On March 6, 2011, the National Conference of Insurance Legislators (“NCOIL”) finalized model legislation intended to provide consumers with information about balance billing practices of facility-based providers. More significantly, the law would require health plans to provide enrollees with information about out-of-pocket costs of elective procedures. The law, if adopted by any state will impose requirements on facilities, facility-based providers and health benefit plans (including health insurers, managed care plans, multiple employer welfare arrangements, an entity that direct-contracts with providers on a risk-sharing basis) to inform patients about balance billing practices by facility-based providers who are out-of-network with the patient’s health plan.
Once upon a time, several practitioners formed a group. The group signed a contract to receive referrals from a network. The group never did receive referrals from the network. One day the group split up and one particular practitioner continued practicing alone.
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