Friday, January 31, 2014

Part II: Understanding All-Payer Claims Databases

Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems.  Nine states currently have APCDs in place, but Kentucky is not one of them.  These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs?

APCDs were developed before the enactment of the Affordable Care Act, but with the subsequent national focus on quality and cost containment, it is easy to see why these systems have gained tremendous popularity in recent years.

Part I: Understanding All-Payer Claims Databases

Over the last decade, many states have established all-payer claims database (“APCD”) systems that collect medical, pharmaceutical, and dental eligibility and claims information.  Payers, including insurance providers, third-party administrators, prescription drug plans, Medicaid, and Medicare, are responsible for depositing eligibility and claims data into a collective system. The data can then be used to generate important information about cost and quality of care. By gathering detailed information in one place, a statewide picture emerges – information on service providers, patient demographics, and other important healthcare data.

Wednesday, January 8, 2014

The Sun is Not Setting on the EHR Safe Harbor

The Centers for Medicare & Medicaid Services and the U.S. Department of Health & Human Services Office of the Inspector General recently announced that the regulation allowing certain healthcare entities to donate electronic health records (with the entity subsidizing up to 85% of the donor’s costs) to physicians has been extended to December 31, 2021. The regulation, which provided a safe harbor from the Stark Law and anti-kickback statute, was set to expire on December 31, 2013.

Monday, January 6, 2014

“Essential Benefits” Will Lead to
More Patients for Some Providers

In a 2009 speech to the American Medical Association, President Obama promised, “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” This declaration came as the health care law was being written, and similar statements were repeated by the President after the bill became law.

By August, waves of cancellation notices were being mailed to policy holders stating that they could not keep their current health care plan, after all. This came as no surprise to those in the insurance and health care industry who have spent countless hours working to implement Affordable Care Act provisions. It was inevitable that many policies would have to be cancelled in light of the ACA’s ten essential health benefits provision and ban on pre-existing conditions.