Managed Care Contract Issues
Matthew Brunson Roberts of Nexsen Pruet
This article reviews managed care contract issues and suggests providers should negotiate clean claim language and penalties for the payors failure to pay such clean claims within a timely manner.
Operational Policy Letter: Medicare + Choice (M+C) Organization Appeal and Grievance Data Disclosure Requirements
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services which provides information on Medicare + Choice organization appeal and grievance data disclosure requirements.
PSOs: A New Opportunity for Providers
Jodi B. Laurence of Broad and Cassel
For many years, hospitals and physicians have been lobbying to be able to contract directly with Medicare beneficia.
Connecticut's Largest Law Firm Using Preventive Medicine to Block Exposure to Health Care Fraud
Day Pitney LLP
Connecticut's largest law firm is tapping expertise from each of its offices to create a special task force to addr.
Managed Care: Managed Costs or Managed Medicine?
Susan Leach DeBlasio of Tillinghast Licht LLP
Many people believe that the rising costs of medical care in the United States, and the increasing numbers of ordinary citizens who cannot afford it, have combined to threaten this country's social and economic health. By the year 2000, unless fundamental changes occur in the health care delivery and financing system, these costs will rise to $1.6 trillion, or 16.4 percent of the GNP.
The HIPAA Hook: Medical Flexible Spending Accounts and Employee Assistance Programs Pull Fully Insured Employers into the HIPAA Privacy Compliance Net
Philip L. Gordon and Steven J. Friedman of Littler Mendelson, P.C.
The popularity of medical FSAs and the prevalence of EAPs means that many employers, even those with fully-insured medical, dental, and vision plans, will need to address compliance with the HIPAA Privacy Rule before the April 14, 2004 compliance deadline. Employers who have failed to bring their medical FSA or their FSA into compliance with the HIPAA Privacy Rule may then discover a costly Achilles' heel.
New Guidance on Administration of Health Care Plans
Faegre & Benson LLP
This update summarizes two recent guidance reports from the Department of Labor and Health Human Services in which the Department provided clarification of the Woman's Health & Cancer Rights Act of 1988 and the National Medical Child Support Notice.
Records Management Programs: An Essential Element of Corporate Compliance
Anne Novick Branan of Broad and Cassel
On August 14, 1997, the Wall Street Journal reported that federal prosecutors claimed to have evidence that Columbi.
Proposed VA Rules Broaden Authority To Purchase Health Care Services, Ease Procurement Requirements
DLA Piper LLP
This Health Care Contracting Bulletin discusses a proposed rule under the Veterans? Health Care Eligibility Reform Act implementing the simplified acquisition provisions of the Act.
Medicare: Administrative Appeal Process and Judicial Review
T. Daniel Hollaway of Hollaway & Gumbert, PC
By this time, virtually all medical providers are routinely providing services to Medicare beneficiaries who have .
PAYERID: More Than A Number
Dept. of Health and Human Services
Publication from the Department of Health and Human Services which outlines the development of PAYERID in order to simplify, standardize, and otherwise improve the process of exchanging electronic health care information.
Questions and Answers for Medicare Beneficiaries Who Lose Managed Care Coverage
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which provides answers to questions about non-renewals of Medicare contracts by certain managed care programs and the choices available to beneficiaries and Medicare for supplemental insurance.
Frequently Asked Questions: What is Medicare
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which answers frequently asked questions from consumers about Medicare.
OIG Issues Hospital Compliance Guidelines
Waller Lansden Dortch & Davis LLP
The OIG released its official hospital compliance guidelines on February 11, 1998. The model compliance guidelines,.
Medicare
Social Security Administration
This publication provides information about Medicare hospital insurance and medical insurance.
Sanction Authorities and Their Application to Parent, Subsidiary and Brother and Sister Organizations
Gabriel L. Imperato of Broad and Cassel
The United States Congress has consistently expanded the administrative sanction authority of the Office of Inspect.
New Outpatient PPS Regulations and Provider-Based Status
Robert B. Ramsey of Buchanan Ingersoll & Rooney PC
On April 7, 2000, the Health Care Financing Administration (HCFA) issued final regulations regarding the P.
Larsen Reins In HMOs; No New Regulations Needed
Tydings & Rosenberg LLP
As Insurance Commissioner Steven B. Larsen ends his first year as head of the Maryland Insurance Administration ("M.
Fraud In Managed Care Part II
Cadwalader, Wickersham & Taft LLP
This is the second of three columns that discuss fraud in managed care programs. The first, published on Sept. 30,.
Questions and Answers Regarding Notice Requirements Under The Women?s Health and Cancer Rights Act of 1998
Dept. of Health and Human Services
Publication from the Department of Health and Human Services answering questions regarding the notice requirements in the Women's Health and Cancer Rights Act of 1998.
HIPAA Compliance and Prospective and Existing Clients
Robert C. Christenson of Fisher & Phillips LLP
Professional Employer Organizations ("PEOs") often encounter health information pertaining to the employees of prospective clients, or to their co-employees. This article explores how HIPAA's new privacy rules impact PEOs both in the client in-take process, and after the PEO has become a co-employer.
Department Of Labor Issues Guidance on Women's Health and Cancer Rights Act Of 1998 Notices
Bodman LLP
You will recall that the Women's Health and Cancer Rights Act of 1998 (WHCRA) added Section 713 to the Employee Ret.
The Antitrust "Dos" and "Don`ts" for Physician Networks
Coudert Brothers LLP
As the health care industry continues to move from traditional fee-for-service arrangements to managed-care concep.
Rate Regulation Under California's Prop 216: Costs Without Benefits
Hilary N. Rowen of Thelen LLP
This article is a critical look at what impact propositions 214 and 216 will have on health care providers and their ability to set fees for their services.
The New HIPAA Privacy Rule -- What is it and who should care?
John A. Rosendahl of Williams Kastner
HIPAA is the Health Insurance Portability and Accountability Act of 1996. In trying to streamline the complicated and fragmented health care system and reduce costs, Congress included within HIPAA what it entitled "Administrative Simplification" provisions, designed to make it easier and cheaper for health care providers and health plans to transmit health information electronically.
Physician Unionization
Dawn Lankford Bowling of Broad and Cassel
An increasing number of physicians are seeking to join or form unions. Hospital-based physicians have effectively u.
Small Business Health Insurance
Small Business Administration
This Small Business Administration publication provides information on the health insurance options available to small businesses.
The Health Insurance Reform Act of 1996
Gabriel L. Imperato of Broad and Cassel
The Health Insurance Reform Act of 1996 ("Act"), which goes into effect July 1, 1997, contains sweeping revisions o.
Medicare Contract Non-Renewal Questions and Answers
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which provides answers to some common questions about recent health care plans' decisions to non-renew their Medicare contracts in certain areas. The document is based on questions received from beneficiaries, members of Congress, state officials, beneficiary advocates, and others.
Politics and Your Healthcare
The Crow Law Firm
The American public has always wanted quality, affordable healthcare and union families are no exception. Since 19.
Medicare + Choice
Railroad Retirement Board
Brochure from the Railroad Retirement Board which discusses how Railroad retirement beneficiaries, like social security beneficiaries, are being offered additional health care options under the new Medicare + Choice Program provided by the Balanced Budget Act of 1997.
Fact Sheet: Protecting Medicare Beneficiaries After HMOs Withdraw
Dept. of Health and Human Services
Fact sheet prepared by the Department of Health and Human Services which describes how Medicare beneficiaries benefits are protected when an HMO withdraws its existing Medicare contract.
New Health Options Available Under Medicare+Choice
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which describes new Medicare options available to consumers under the Medicare+Choice plan.
Provider-Based Status: Proposed Rules Require Advance Determination
Patricia Owen Powers of Waller Lansden Dortch & Davis LLP
The Health Care Financing Administration (HCFA) proposed rules on Sept. 8 for the payment of hospital outpatient se.
Electronic Medical Records - Health Care's Next Challenge in Cyberspace
Tillinghast Licht LLP
The quest for health care reform and the dynamic growth of integrated delivery systems have led to significant developments in the application of information technology to the health care industry. Multiprovider organizations now link computers on different floors, at different offices, and in different states to share patient information throughout an integrated network.
Virginia Health Law Update
Charles V. Mehler of Woods Rogers PLC
Quality of HMO Plans. Creates a framework for statutory and regulatory oversight of Managed Care Health Insurance .
Exceptions for Specific Delivery Systems and Health Care Providers and Suppliers
Broad and Cassel
The proposed Stark II regulations have also carved out specific exceptions for certain providers and suppliers of h.
Changes in Physician Incentive Plan Regulations
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services to Medicare Managed Care Organizations State Medicaid Agencies which outlines changes made in the regulations regarding physician incentive plans.
DWT Releases Comments on OIG'S Issuance of Compliance Resource Guide for Corporate Boards
of Davis Wright Tremaine LLP
The Office of the Inspector General of the Department of Health and Human Services (OIG), working in collaboration with the American Health Lawyers Association, just published Corporate Responsibility and Corporate Compliance: A Resource for Healthcare Boards of Directors ("Board Compliance Guide"). In the wake of Enron, Sarbanes-Oxley and various agency pronouncements, unprecedented attention is being given to the roles and responsibilities of corporate boards.
New External Appeal Law in New York
Jackie Huchenski of Moses & Singer LLP
The New York State Legislature recently passed a law permitting independent external appeals for denials of covera.
Managed Care Contracts - Key Provisions for Providers
Susan Leach DeBlasio of Tillinghast Licht LLP
The contract between a physician or other health care professional and a managed care organization (MCO) such as a provider-sponsored network, integrated delivery system, health maintenance organization, or other health care plan, is the fundamental document which frames, defines and governs their relationship. Contractual provisions can affect payment, office organization, practices and procedures, and confidential records as well as clinical decision-making.
Managed Health Care and You
Brian P. O'Conner of Ginsberg & O'Connor, P.C.
Many individuals receive their major medical insurance through an employee benefit plan. Often, these employee plans are subscribers to a Health Maintenance Organization (HMO).
How to Resolve a Grievance with an HMO
This article details the HMO grievance process in the State of Florida.
Legal Insurance Plans
Sokoloff and Weinstein, P.A.
Although not new, legal insurance plans are gaining acceptance at an ever increasing rate. Legal insurance plans mo.
The Truth About Texas' Prompt Payment Laws For Healthcare Providers
T. Daniel Hollaway of Hollaway & Gumbert, PC
The intent of this article is twofold. First, I hope to set the record straight about the legal .
How "Clever" Personal Injury Lawyers Proceed in 2002
Victor E. Schwartz of Shook, Hardy & Bacon L.L.P.
Most corporate defendants begin their work on cases when they have received notice of a claim or are served with process, but that is not when personal injury lawyers begin and plan lawsuits in 2002. When modern personal injury lawyers target tobacco companies, pharmaceutical companies, insurers and other so-called "unpopular" industries, they begin by vilifying the company, and sometimes an entire industry, in the media.
Managing Employee Benefits
Small Business Administration
This publication provides information on how to manage employee benefits at a small business.
When Physicians Try to Unionize Against HMOs
Cadwalader, Wickersham & Taft LLP
”I'm sorry, the doctors can't see you today. They are on strike.” Is this a possible scenario? Given the dissatisfaction felt by many doctors over the increasing power of managed care plans, health maintenance organizations (HMOs), preferred provider organizations and other networks it is not hard to imagine.
The Women's Health and Cancer Rights Act of 1998: General Questions and Answers
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services answering questions regarding the Women's Health and Cancer Rights Act of 1998.
Frequently Asked Questions About Security and Electronic Signature Standards Under the Health Insurance Portability and Accountability Act
Dept. of Health and Human Services
Answers to questions regarding the new standards developed to protect the confidentiality, integrity, and availability of individual health information under the Health Insurance Portability and Accountability Act.
Rhode Island's New Consumer Orientated Health Care Law: A Model
Susan Leach DeBlasio of Tillinghast Licht LLP
Health care professionals and providers, insurance companies and health maintenance organizations ("HMOs"), and individual consumers and groups are all praising the passage of the "Health Care Accessibility and Quality Assurance Act" (the "Act") by the Rhode Island legislature this July. Patterned after the American Medical Association's "Patient Protection Act," the new law empowers the state Department of Health to regulate and monitor managed care plans to ensure a proper balance between the rights of the plan, the people who pay the premiums, and the patients who receive the care.
New Jersey's Hint Bill Advances Administrative Simplification
Edward F. Shay of Saul Ewing LLP
The State of New Jersey has enacted S-323, legislation intended to promote and standardize electronic data interch.
HMO Medical Directors and Professional Sanctions
Cadwalader, Wickersham & Taft LLP
ONE OF THE ONGOING accomplishments of managed care has been the ability of health maintenance organizations (HMOs) .
New Insurance Requirements for Networks
Rodger L. Hochman of Broad and Cassel
In the recently ended 1997 legislative session, the Florida Legislature passed a bill which could seriously affect .
New Florida Legislation Insulates Health Care Entities from Liability and Reduces Costs for Credentialing Certification
Michael P. DeVoe of Broad and Cassel
Credentialing is the process of assessing and validating the qualifications of a licensed health care professional..
Medicare+Choice Offers Opportunities for Providers
Deborah W. Larios of Waller Lansden Dortch & Davis LLP
The Medicare+Choice program may be the most significant change in Medicare since its inception in 1965, according .
The Wedding Cake Falls: An Update on Same-Sex Marriage and Domestic Partner Issues After the San Francisco Marriage Decision
Nancy L. Ober and Paul R. Lynd of Littler Mendelson, P.C.
Ruling in a pair of cases challenging the issuance of same-sex marriage licenses by the City and County of San Francisco, the California Supreme Court held that San Francisco officials exceeded their authority. The Court also held that the approximately 4,000 same-sex marriage licenses issued by San Francisco were void from the inception.
Program of All-Inclusive Care for the Elderly: Questions and Answers
Dept. of Health and Human Services
Brochure from the Department of Health and Human services providing answers to questions regarding the program of all-inclusive care for the elderly.
Virginia Health Law Legislation
Woods Rogers PLC
Access to Emergency Treatment. Amendment to Virginia Code ? 38.2-4312.3 provides members of health maintenance orga.
An Overview of the Health Law Specialty
Cadwalader, Wickersham & Taft LLP
THE HEALTH CARE industry is the largest sector of the United States economy, accounting for $1 trillion in annual e.
Managed Care Challenged in Class Action Lawsuit
Pillsbury Winthrop Shaw Pittman LLP
This alert summarizes the allegations in the Humana Class Action Suit.
Health Industry Alert--October 6, 1999
Akin Gump Strauss Hauer & Feld LLP
On September 27, 1999, California Governor Gray Davis signed into law an impressive "package" of new health care bills affecting the managed care industry in California. Although many of the 21 new laws take effect as late as January 1, 2001, there is little question that the new legislation will have immediate and far-reaching effects on the managed care industry throughout the country.
Health Care Services Update
Carol A. Ferri and Sharon R. Klein of Pepper Hamilton LLP
This update discusses the new standards issued by the U.S. Department of Health and Human Services for electronic transactions and code sets for the processing of health care claims.