Early this year, the U.S. Supreme Court ruled that the North Carolina State Board of Dental Examiners (Dental Board) violated the federal antitrust laws by preventing non-dentists from providing teeth whitening services in competition with the state’s licensed dentists in North Carolina State Board of Dental Examiners v. FTC, 135 S. Ct. 1101 (2015). The Dental Board had contended that its activity was immune from antitrust scrutiny under the “state action” doctrine because it was an exercise of the state’s sovereign power. The Court rejected that contention and upheld the Federal Trade Commission’s determination that the Dental Board’s enforcement actions against teeth whitening competitors had illegally restrained trade and did not amount to protected “state action.” To be protected, a state licensing agency such as a board of dentistry or of medicine that is made up of active members of the professions they regulate, such as practicing physicians, must be “actively...
CMS released the long-awaited final rule on the Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 through 2017 (Final Rule) on October 6, 2015. In this rule, CMS made significant changes to current “Meaningful Use” (MU) requirements with the intent to ease the reporting burden for physicians and other providers and to support interoperability.The Electronic Health Record (EHR) Incentive Program was established by the American Recovery and Reinvestment Act of 2009. Separate Medicare and Medicaid programs provide for incentive payments to eligible professionals (EPs) who are meaningful users of certified EHR technology. The last year in which EPs could earn a Medicare incentive payment was 2014; the Medicaid program provides for incentives through 2016. Starting on January 1, 2015, EPs who do not demonstrate MU under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program are subject to a payment “adjustment” or penalty—unless...
Have you conducted an enterprise-wide analysis of the risk of a loss of unsecured electronic protected health information (ePHI)? Do you have in place a written policy specific to the removal of hardware and electronic media containing ePHI into and out of your office or OR suite?Negative answers to those two questions were the major factors behind the ePHI breach that led to a $750,000 penalty levied against Cancer Care Group, P.C., a 13-physician radiation oncology practice with facilities throughout Indiana. In August, 2012, the Cancer Care Group notified the Office of Civil Rights (OCR) in the Department of Health and Human Services that a laptop bag had been stolen from an employee’s car in Indianapolis, Indiana a month earlier. According to the report, the laptop bag contained the employee’s computer, which did not contain ePHI, and computer server backup media, which contained the ePHI of approximately 55,000 individuals. The ePHI...
In last week’s Alert, we looked at Medicare’s Value-Based Modifier (VM) and the Quality and Resource Use Reports (QRURs) that will explain how the VM will affect individual payments. This week we will take a closer look at where Medicare’s move from volume to value will be heading after the VM system sunsets at the end of 2018, as laid out in the payment reform legislation (H.R. 2) that did away with the Sustainable Growth Rate (SGR) methodology in April of this year:
Starting in 2019, the amounts paid to eligible professionals (EPs) will be subject to adjustment for “value” through either the MIPs or an APM, depending on which option the individual EP selects.
The MIPS will replace three cumbersome, costly and almost-unintelligible programs, i.e., the VM, the Physician Quality Reporting System (PQRS) and the Meaningful Use [of Electronic Health Records] incentive program. In concept, at least, it represents a...
The United States Supreme Court has again upheld the Affordable Care Act (ACA). The Court announced its decision in a 6-3 ruling in King v. Burwell on Thursday, June 25, 2015.Some 6.4 million Americans were at risk of losing their “Obamacare” health insurance coverage had the Court invalidated the ACA and eliminated the subsidies that made the insurance affordable. The cost of insurance was predicted to rise dramatically for millions of others as the pool of participants in the individual markets shrank.Six words provided the basis for the challenge brought by four individual plaintiffs in Virginia: “an Exchange established by the State.” The statute provides for a premium tax credit (i.e., a subsidy) for “health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established...