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Below is a summary of UPMC-Highmark dispute as of March 4, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012. May 1, 2012 – Parties enter into mediated agreement which states that parties (UPMC and Highmark) will allow in-network access for all commercial, Medicare and Medicare Advantage members through December 31,…
Below is a summary of UPMC-Highmark dispute as of February 22, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012. May 1, 2012 – Parties enter into mediated agreement which states that parties (UPMC and Highmark) will allow in-network access for all commercial, Medicare and Medicare Advantage members through December 31,…
As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019. CMS explained this initiative under the “Transparency” and “Request for Information” topics in the following link:  https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2019-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute-0 CMS subsequently issued two sets of Frequently Asked Questions (FAQs) regarding this rule. Essentially, the guidance states as follows: Hospitals are free to choose whatever format…
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The U.S. Department of Health and Human Services, Office for Civil Rights (“HHS”) just announced an $111,400 settlement and substantial corrective action plan for a Colorado hospital whose former employee still had access to electronic patient protected health information (“PHI”). In 2013, Pagosa Springs Medical Center failed to de-activate a former employee’s username and password for a web-based scheduling calendar, which included patients’ electronic PHI.  Further, the hospital failed to have a business associate agreement…
“Eliminating Kick-Backs and Recovery Act of 2018” (EKRA) is a part of a group of laws recently passed by Congress to expand the law enforcement spectrum available to fight the opioid epidemic. EKRA is part of approximately 70 separate actions referred to as the SUPPORT Act, i.e. Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients in Communities Act. EKRA adds a new Anti-Kickback rule to the existing healthcare fraud enforcement spectrum. It…
In October 2018, the National Practitioner Data Bank (NPDB) published the third edition of the NPDB Guidebook. NPDB publishes monthly “NPDB insights”.  I could not send the link to that, but I have attached a copy of the page announcing the new Guidebook here:  NPDB Insights. I am also attaching a link to the Guidebook.  https://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp You can also obtain all of these by logging on to the NPDB homepage:  https://www.npdb.hrsa.gov/  …
Dietrich, Danielle
The U.S. Department of Health and Human Services, Office for Civil Rights (“HHS”) just announced a $125,000 settlement for a disclosure of patient protected health information (“PHI”) to a reporter. In 2015, a patient of Allergy Associates of Hartford, P.C. (“Allergy Associates”) contacted a local TV station about a dispute that the patient had with Allergy Associates regarding her use of a service animal.  A reporter for the TV station contacted Allergy Associates for comment,…
The final Medicare 2019 Physician Fee Schedule https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html rule was posted on November 1, 2019, to be effective January 1, 2019.  It includes Section II(D) entitled “Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services”, with several subsections. Brief communication technology-based services (EG Virtual Check-In) (HCPCS Code G2012) Remote evaluation of prerecorded patient information (HCPCS Code G2010) Interprofessional Internet Consultations (CPT Codes 99451, 99452, 99446, 99447, 99448 and 99449) Additional Medicare Telehealth Services Expanded Telehealth…
Opioid Update: New Federal Law – The Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act On October 24, 2018, President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act (H.R. 6).  According to the White House, this Act “addresses the opioid crisis by reducing access to and the supply…