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Showing 9 posts from April 2015.

HIPAA Rules and Procedures in the Event of a Data Breach, Part Two

My last post focused on the discovery and investigation of a data security breach to determine if breach notification is needed. Today’s post now turns to the requirements of breach notification triggered by a data security breach. More >

HIPAA Rules and Procedures in the Event of a Data Breach, Part One

As discussed in my prior post, recent massive data breaches at major retailers and health insurance providers paint a bleak picture of modern data and emphasize the importance of strong security safeguards and plans for handling suspected security breaches for electronic protected health information (“ePHI”). In the healthcare context, a security breach of a covered entity or a Business Associate’s (BA) data security system triggers the Security Rule and can trigger certain breach notification requirements under Health Insurance Portability and Accountability Act (“HIPAA”) and Health Information Technology for Economic and Clinical Health Act (“HITECH”). This post will discuss the investigation needed to determine whether a breach has taken place, while the next post will discuss the necessary notifications in the event of a breach. More >

Pharmacists: Aren’t you really providers already? – Part Two

The first part of this article discussed pharmacist provider status and argument both for and against it. Today’s post now turns to regulatory hurdles, developments towards provider status and the acknowledgment of changing roles in the pharmacist workforce. More >

Pharmacists: Aren’t you really providers already? - Part One

While the passage of the Patient Protection and Affordable Care Act (“ACA”) ushered in a new era of access to health care, it only served to exacerbate a growing crisis in the provision of health care – lack of providers. As of April 2015, the Health Resources and Services Administration lists the population of the United States that lives within a health professional shortage area (“HPSA”) for primary care as 103,847,716, with 1,023,989 of those living in Kentucky.[1] This shortage calls for a reimagining of ways that non-physician providers can fill the care gap, and the debate surrounding the provider status of pharmacists with regard to federal health care programs is evidence of a changing mindset. More >

Five Things to Know about Transitional Care Management

Tuesday’s post discussed the basics of Transitional Care Management (“TCM”), but today’s post will focus on five things that providers should know about TCM. More >

HEALTHCARE NEWS ALERT: Congress Passes Repeal of Sustainable Growth Rate

Posted In Medicare

In a 92-8 vote on Tuesday, the Senate passed a bipartisan measure to repeal the Medicare payment formula known as the Sustainable Growth Rate. This bill was part of a deal negotiated in the House between House Speaker John Boehner and Minority Leader Nancy Pelosi in March, and it was approved with equally overwhelming numbers in that chamber. President Obama is expected to sign the legislation, which prevents health care providers from receiving a 21 percent cut in Medicare reimbursement rates. The bill will also fund the Children’s Health Insurance Program and community health centers for two further years.  To pay for the bill, high-income seniors will cover more of their Medicare costs out of pocket, and Medigap plans will require basic co-payments. More >

Five Key Elements of Transitional Care Management

Similar to rules providing billing opportunities for chronic care management (as discussed in this McBrayer blog post), relatively new Medicare funds for Transitional Care Management (“TCM”) provide a new path for providers to supplement their Medicare practice with payment for services they may already provide. Beginning in 2013, Medicare, for the first time, allowed providers to bill for thirty days of TCM, incentivizing post-discharge care with an aim to prevent hospital readmission. The Center for Medicare and Medicaid Services (“CMS”) requires five specific elements of TCM to be met before provider reimbursement. Those elements merit review and brief discussion today, while Thursday’s post will discuss five important points of consideration with regard to TCM. More >

Certificate of Need Modernization in Kentucky

The Certificate of Need (“CON”) program is a regulatory review process used to promote responsive health facility and service development, rational health planning, health care quality, access to health care, and health care cost containment. Since its beginning as part of the federal Health Planning Resources Development Act of 1974, states have both developed and repealed respective CON programs. Currently, approximately 36 states, including Kentucky, retain some type of CON requirements for certain health care providers and services. More >

Important Recommendations from the MedPAC March Report to Congress, Part Two

Posted In Medicare, Part D

Important Recommendations from the MedPAC March Report to Congress, Part Two More >

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