Governing AI Use in Healthcare Claims Administration
Calculators, or “adding machines” as they were once called, once represented revolutionary technology.
Navigating the New HHS Information Blocking Disincentives
The U.S. Department of Health and Human Services (HHS) recently finalized a rule that establishes “disincentives” for healthcare providers found to have engaged in information blocking.
CMS’s New Rule Increases Regulatory Oversight for Medicare Advantage Plans
The Centers for Medicare & Medicaid Services (CMS) issued its final rule revising the Medicare Advantage (MA) Program.
Supreme Court Contemplates Overturning Chevron Doctrine: Implications for Healthcare Industry Hang in the Balance
The U.S. Supreme Court continues to build its legacy of jettisoning well-established principles and practices.
CMS’ Crackdown on Medicare Advantage – A Legal Perspective
Over the years, Medicare Advantage (MA) managed care plan violations have made national headlines for lack of transparency in reporting, access to care issues, and questionable financial practices.
Beyond Faith: Can Hospitals Collect When Patients Rely on Sharing Ministries?
Enrollment in HealthCare Sharing Ministry (“HCSM”) plans has been on the rise, with one report finding that more than 1.7 million Americans use HCSMs as their primary health coverage.
Winning Arbitration and Litigation Through Preparation
Understanding the quality of the claims early can save clients money, aid in determining how much to accept as settlement, and avoid unwanted surprises at the eleventh hour.
The No Surprises Act: Will Providers Hit the Home Run in the Baseball-Style IDR Arbitration?
Congress enacted the bipartisan No Surprises Act (“NSA”) to end surprise medical bills for emergency services.
Key Takeaways From the CMS 340B Proposed Hospital Reimbursement Plan
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining a one-time lump sum payment of $9 billion dollars to be given to approximately 1,649 participating 340B hospitals.
CMS Final Rule regarding Medicare Advantage Plans
On April 5, 2023, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule for Medicare Advantage (“MA”) Plans, confirming that MA Plans must follow the 2-Midnight Rule, its case-by-case exception, the inpatient-only (“IPO”) list, as well as traditional Medicare coverage criteria.
