For a provider of healthcare services, payer audits are always a possibility. Both government and private payers consistently monitor providers to prevent fraud, overpayment, and improper billing or coding procedures. Audits can be nerve-racking and intimidating, even if a provider is billing correctly. Improper billing can lead to civil and criminal sanctions. To alleviate some…
Understanding your compensation is critical before you decide to accept a job. In the world of medical practices or groups, however, this understanding is even more essential, because a wide variety of compensation structures for physicians exists. These compensation models can dictate not only what a physician will make in the near future, but also…
If you are a news junkie, then you know that a tick-tock is a story that relies heavily on chronology, counting down the events of the day, in order, as inexorably as the ticking clock. These types of timeline stories have become very popular in the fast-paced world of modern politics, in which readers eat…
WASHINGTON (Reuters)—The U.S. Justice Department will argue the federal government deserves reimbursement for costs it has borne stemming from the opioid crisis in a “statement of interest” it plans to file in a lawsuit against drug manufacturers and distributors, U.S. Attorney General Jeff Sessions said on Tuesday. “I am announcing today that the department will…
On Dec. 20, 2017, Congress passed a massive tax bill that will have an impact on nearly every individual and business in America. The bill makes sweeping revisions to existing tax provisions, and it will largely affect the health industry. Individual Mandate Repealed The bill repeals the individual mandate established in 2005 by the Affordable…
SAN DIEGO—During a session at the ACR/ARHP 2017 Annual Meeting Nov. 3–8, three representatives from the federal government described several of the government’s varied national strategies and agencies that are tackling pain. All of these strategies are affected by the current national epidemic of opioid overdoses and the need for safer analgesic prescribing. But the…
The ABCs of MACRA The transition year under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is at an end. MACRA repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a value-driven payment system. The new approach to payment is called the…
BOSTON (Reuters)—United Therapeutics Corp will pay $210 million to resolve U.S. claims that the drugmaker used a charity as a conduit to illegally cover Medicare patients’ out-of-pocket drug costs in order to eliminate price sensitivity and to boost sales. The U.S. Attorney’s Office in Massachusetts on Wednesday announced the settlement, one of the first to…
(Reuters)—A U.S. trade association representing medical laboratories filed a lawsuit on Monday challenging a new reimbursement system used by the federal government that it said would reduce how much Medicare pays for labs by about $670 million in 2018. The American Clinical Laboratory Association (ACLA) in a lawsuit in federal court in Washington, D.C., said…
(Reuters)—U.S. drugstore chain operator CVS Health Corp said on Sunday it had agreed to acquire U.S. health insurer Aetna Inc. for $69 billion, seeking to tackle soaring healthcare spending through lower-cost medical services in pharmacies. This year’s largest corporate acquisition will combine one of the nation’s largest pharmacy benefits managers (PBMs) and pharmacy operators with…