Managed Care Contracting & Provider Payment

Quick Post: FTC Delays Enforcement of Red Flag Rules Until August 1st

The FTC announced yesterday that it will once again delay enforcement of its controversial Red Flag Rules ... this time until August 1st.  They also plan to provide additional guidance for "low risk" creditors in the form of a template.

Provider Readiness for May 1st Red Flag Rule Enforcement Deadline

According to a study conducted by IdentityForce and published last week:

Only 17.5% of hospitals surveyed reported they were in compliance with the Red Flag Rules.

Approximately 53% were in the process of designing and implementing their compliance programs.

Approximately 24% were still evaluating their options.

IdentityForce is a company that offers Red Flag, identity theft and Identity misuse prevention and compliance tools.

A link to the report is: Here

Link to post noting delayed enforcement date: Here

The Red Flag Compliance Train is coming down the Track and Payors are Asleep at the Switch.

Now, as we all know, the deadline for enforcement of the Red Flag Rules is looming … May 1^st.  Providers are struggling to implement red flag compliance policies.  It’s another big PROVIDER compliance panic.

In Face of Physician Protest over Red Flag Rules FTC Stresses Flexibility

Quick post:  Here is a link to an article in today's AMA News on the continued controversy over including physicians in the definition of "creditors" under the red flag rules.  The AMA promises guidance on compliance with the Red Flag Rules by April 10th.  Medicine slams FTC over forcing physicians to police identity theft

New Hampshire “HIPAA” legislation debated; NH House Bill 580 would replace previous medical records law with broad patient rights.

Current law recognizes that medical records are the property of the patient and allows the patient to obtain a copy of the records.  Current law forbids a provider from disclosing “confidential communications or information” about a patient without patient consent, except as provided for by law or to protect the welfare of the individual or the public interest.  Current law also forbids using any patient identifying information for sales purposes without the patient’s written authorization.  

The proposed legislation would continue these provisions and would recognize a broader right of patients to control access to their information and to be able to find out who has had access to that information. 

New York Attorney General Reaches Agreement with United HealthCare to Shut Down Ingenix - Aetna also agrees to Discontinue Use of Ingenix

On Tuesday, United HealthCare agreed to the terms of a settlement proposed by the New York Attorney General to end the investigation into the practices if its subsidiary, Ingenix, Inc.  (Link to earlier post about the investigation.)  The settlement, requires United HealthCare to

1st Circuit Upholds New Hampshire Law Banning Disclosure of Physician Prescribing Information

This past November 18^th, the 1^st Circuit overturned a lower Court decision and held that an “innovative” New Hampshire approach aimed at curbing increasing drug prices was not an un Constitutional abridgement of free speech.  The law prevents companies that mine prescription data from selling it to pharmaceutical companies for use by their drug detailers to attempt to influence prescribing patterns. 

National Conference of Insurance Legislators Adopts Model Legislation Banning Silent PPOs

This past Sunday, the Executive Committee National Conference of Insurance Legislators (“NCOIL”) adopted model legislation intended to stop the activities of “Silent PPOs”.  A “Silent PPO” is an arrangement where one organization buys or uses a discounted rate for services from a health provider or practitioner without the provider’s knowing authorization.[1] 

REVISED Link to Article on "Never Events" published in the ABA Health Lawyer

I previously published a link to the ABA Health Lawyer Article I wrote entitled "What Are Never Events, and Why Do They Matter?"  The link took you to a web site that only allows paid subscribers to view the article.  Out of courtesy to the publication, I waited to provide free access through this column. 

Because several weeks have passed since publication and also because someone has published my article on their personal website without my permission or the permission of the ABA, I am now providing access the article by clicking this link Download Article reprinted from The ABA Health Law Section's publication "The Health Lawyer", vol. 21, Number 1.

Red Flags Rules and What they mean to Health Care Providers

The following is a rather long post, but is an excerpt from a recent talk I gave on the subject.