It Looks Like 2014 Will Fulfill The Chinese Curse: “May You Live In Interesting Times.”
Providers enter 2014 with a background of 5,000,000 policies being cancelled as of December 31, 2013. One million individuals potentially signed up under the exchanges, however, it is not clear how much of that information has been appropriately transferred to the insurance companies and whether or not the insurance companies have activated those policies by receiving […]
CONFUSION
Obviously events in the Affordable Care Act area are breaking fairly quickly. As you may or may not be aware, the Administration has asked the insurance companies to provide insurance for those individuals who pay for their insurance coverage by January 10th. It is my understanding that certain carriers are willing to accept the January […]
ANY WILLING PROVIDER LAWS PROPOSED
There are many skirmishes taking place in the implementation of the Affordable Care Act. One deals with the narrowing of the provider networks, resulting in the exclusion of a number of providers from the networks being offered under the various plans on the exchanges, and in some cases, even those plans being offered outside of […]
Extension of Affordable Care Act Sign-Up Deadlines May Create Insurance Verification Uncertainty For Providers
Last week, the Centers for Medicare and Medicaid Services (“CMS”) issued an interim final rule which requires insurers to provide coverage effective January 1, 2014 through the health insurance exchanges to any individual who selects coverage through December 23, 2013. In the preamble to the interim final rule, CMS stated that “ an effective coverage […]
UNITED HEALTHCARE ENJOINED FROM TERMINATING PHYSICIANS FROM MEDICARE ADVANTAGE PLANS IN CONNECTICUT
On December 5, 2013, Judge Stefan Underhill of the U.S. District Court for the District of Connecticut issued a temporary restraining order and preliminary injunction against various United Healthcare (“United”) entities that had terminated approximately 2,200 Connecticut physicians as participating physicians in United’s Medicare Advantage program. After a number of its members received termination letters, […]
“Doc Fix” – The Continuing Saga of the Sustainable Growth Rate
To continue our reporting on the implementation of the Sustainable Growth Rate (“SGR”), as we write this on Friday the 13th, 2013, both the House and the Senate are considering bills, that would permanently address the SGR solution (euphemistically known as the “Doc Fix”). The major difference between the two bills being considered is that […]
HORIZON DECISION
As everyone should be aware by now, Horizon has made the decision that it will not extend the policies it cancelled, even though both the President and the Commissioner of Insurance in New Jersey have authorized them to do so. It appears clear that the position of Horizon is that it has committed its resources, […]
No Physician Shortage
In today’s New York Times (December 5, 2013), a guest editorial by Scott Gottlieb, an internist and fellow at the American Enterprise Institute; and Ezekiel J. Emmanuel, the former health care policy advisor to the Obama Administration; representatives of both the right and the left, argue that there will not be a doctor shortage due […]
CMS ADDS PAYMENT FOR CHRONIC CARE MANAGEMENT SERVICES TO MEDICARE PHYSICIAN FEE SCHEDULE
CMS has published the Medicare Physician Fee Schedule Final Rule for 2014. One of the modifications adopted by CMS is the implementation of a separate payment for chronic care management services under the Physician Fee Schedule starting in calendar year 2015. The separate payment will be made for chronic care management services furnished to patients […]