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Showing 3 posts in Payors.

New Rule Brings Sweeping Changes to Physician Privacy

On January 17, the U.S. Department of Health and Human Services (HHS) announced that the Centers for Medicare & Medicaid Services (CMS) would begin granting Freedom of Information Act (FOIA) requests for Medicare reimbursement to individual physicians on a “case-by-case basis.”  The new policy, effective March 18, 2014, is a departure from CMS’ long-standing practice of withholding information on physician reimbursement under the Medicare program. More >

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? More >

Oxford Health Plans, LLC v. Sutter: Don’t Forget to Read the Arbitration Provision

On June 10, 2013, the U.S. Supreme Court issued a decision confirming that payment disputes between a payor and its network providers may be resolved through group arbitration if allowed by the arbitrator, even if the use of class procedures is not expressly provided for in the agreement. More >

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