What is Medicaid?
Medicaid provides health and long-term care financial assistance for certain groups of people with limited income. Medicaid was enacted under title XIX of the Social Security Act as a joint program between the Federal government and all 50 states, the District of Columbia, and the U.S. Territories.
Medicaid became effective January 1, 1966, and currently is the largest source of medical and health-related funding for America’s poorest people. The Federal agency that administers the Medicaid program is the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health & Human Services.
Medicaid programs differ in each state.
Welcome to our guide to Healthcare Buzzwords!
An acronym for “Accountable Care Organization”, an ACO is a model of healthcare delivery in which a group of healthcare providers agree to accept payment for their services based on the aggregated health outcomes of the patients they see, as opposed to the total number of services performed. ACOs reward providers in a “fee for health” model, as opposed to a traditional “fee for service” model. Although the term ACO can apply to a variety of types of organizations, regulations for establishing ACOs to participate in the Medicare Shared Savings Program specifically were included in the Patient Protection and Affordable Care Act of 2010.
The U.S. Department of Health and Human Services (HHS) issued a final rule Friday, February 22nd that implements five key consumer protections from the Affordable Care Act, and makes “the health insurance market work better for individuals, families, and small businesses.”
“Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.“
What are grandfathered health plans?
Mary Pat: Your business is called “Health Security Solutions.” People often confuse privacy with security. Can you clear up the confusion for us?
Steve: The Privacy rules refer to the broad requirements to protect the confidentiality of Protected Health Information (PHI) in all its forms. So for example, a physician talking loudly on the phone in the lobby of a restaurant about a patient by name is a violation of the privacy rules. PHI on paper records is covered under the privacy rules.
The security rules are specifically concerned about protecting the confidentiality (i.e. privacy), integrity and availability of electronic PHI, or PHI that exists in a digital form. So once you are dealing with electronic health records and information systems, violations tend to fall under the security rules. (more…)
On Friday, February 1st, The Centers For Medicare and Medicaid Services (CMS) released their final regulations on the Physician Payment Sunshine Act that was passed as a part of Heathcare Reform in 2010. The PPSA or “Sunshine Act” mandates that any manufacturer of medical supplies, medical equipment or pharmaceuticals will disclose to the Department of Health and Human Services (DHHS) any payments, gifts, or “transfers of value” over $10. The resulting disclosures will be publicly available in a database of transactions so that there will be “sunshine” on any financial relationships, direct or indirect, between providers and manufacturers. All of the disclosure requirements are the responsibility of the vendor, but the public nature of the resulting data has implications for day to day operations in your practice, as well as any relationships you might have with prominent manufacturers.
What is the Purpose of the Sunshine Act? (more…)
If you read my alert from August or the followup article on Audit Red Flags to Avoid, you are aware that CMS hired an accounting firm, Figliozzi & Company, to audit the compliance of eligible providers and eligible hospitals that had already received payment under the meaningful use (MU) program. According to a report from the GAO as many as 20% of eligible providers and 10% of eligible hospitals may be audited, on a post-payment basis to confirm that they actually met the requirements of the program.
I recently had the opportunity to interview a physician that is currently going through the audit process with Figliozzi & Company (an edited transcript of the interview can be found here). Although he wishes to remain anonymous, he was willing to report on his experience and provide redacted copies of the correspondence and requests that he has received from the auditors. (more…)
In our consulting practice we are seeing physicians fleeing hospital employment just when many people are predicting the death of the private medical practice. We affectionately call these physicians our “Single Shingles” and they are approaching private practice much differently. These physicians often bring their spouses into the practice as their business partners, and we teach them how to manage the practice.
Here are some practice models that solo physicians are considering for their Single Shingles.
The Retainer-Based Practice
Although the retainer-based practice has many other names, calling it retainer medicine seems to be the most generic way to describe direct care, or care that patients pay for directly without the intervention of a third-party payer source. There are as many variations of retainer-based practices as there are name variations, but the three main types are listed below.
The tweet above was sent out by a very interesting start up named Sickweather on October 19th of last year. Sickweather analyzes data from Twitter and Facebook to determine potential public health concerns by listening to the things people post on social media. If a lot of people are posting about coughing, sneezing or other symptomatic behavior, you could make the assumption that increased disease activity is more likely in the area. The tweet welcoming flu season early was not an ironclad prediction, announcement, or warning but six weeks later the Centers for Disease Control issued a press release titled “U.S. Flu Season off to Early Start.”
“The tweet welcoming flu season early was not an ironclad prediction, announcement, or warning but six weeks later the Centers for Disease Control issued a press release titled ‘U.S. Flu Season off to Early Start’.”