Healthcare Regulatory Update - 2011

November 29, 2010

For the most current information, view the 2012 Healthcare Regulatory Update

Regulatory Update - October 2010 

  • Healthcare Reform 
  • Ambulatory Services 
  • Hospital Services 
  • Compliance Concerns 
Healthcare Reform
  • Employers Face Tough Calls on Reforms, Including Whether to Become Fully Insured
  • High-Risk Pools Face Delays Despite States’ Efforts to Comply
  • Changing Payer Mix Under Reform Means Mixed Bag for Providers
  • Reform Law Gives Large Fraud Enforcement Powers, but Many Provisions Are Unclear
  • Annual Fee Could Force Higher Premiums, Push Employers Toward Self-Insured Plans
  • CMS Proposes Rule to Expand Medicare Preventive Services
  • NAIC Favors Applying MLR at Subsidiary Level
  • Hospitals Should Plan Now for Value-Based Purchasing
  • Major Health Provisions Staring in 2012
  • Successes in Risk Contracts Spur Interest In ACOs, but Some Fear Impact on Hospitals
  • Specialty Health Plans Seek Spot As Exchanges Get Better Defined
  • California May Vote Soon on Its Exchange, Drawing Keen Interest From Medi-Cal Plans
  • Insurers Prepare for Exchanges By Simplifying Product Options
  • AHIP Will Lobby Legislators, Regulators on Grandfathered Health Plans
  • Insurers Cite Cost Pressures From Reform As Contributing to Rate Hikes This Fall
  • Fears Grow That Early-Retiree Fund Will Run Out Well Before 2014
  • Hospitals Fear Financial Impact of ACOs, Seek Clarifications on Legal Issues, Pay
  • Major Health Reform Provisions Take Effect Sept. 23, 2010
  • Insurers Pull Out of Child-Only Coverage, But Consultants, States See Possible Fixes
  • CMS Proposes Regs to Combat Fraud in Medicare, Medicaid, CHIP
Ambulatory Services
  • Final meaningful use requirements make it easier to earn $44,000 in EHR bonuses
  • E-prescribe in 2011 or your Medicare payments will drop in 2012, 2013
  • Audits to be used by CMs to verify meaningful use by EHR bonus recipients
  • Private payers plan to use CMS’s meaningful use standards to offer EHR incentives
  • Fake health plans on the rise
  • CMS targets observation billing for review after utilization surges
  • Enrollment delays, minimize lost payments and plan effective dates
  • CMs approves two groups to certify EHRs for meaningful use
Hospital Services
  • CMS cuts hospital payments for 2011
  • Moody’s: Medicare Cuts Will Hurt Not-for-Profit Hospitals
  • Use of Routine Medical Care Down During Economic Crisis
  • Employers Revising Benefit Plans in Wake of Reform Law
  • FTC, DOJ Revise Merger Guidelines
  • CBO Projects Rising Healthcare Costs
  • CMS Reminds Providers of Version 5010 Standards Compliance Dates
  • Moody's: Not-for-Profit Medians Improve
  • Nearly 2,000 Employers Accepted into Early Retiree Reinsurance Program
  • CBO: Healthcare Spending Increasing Faster for Obese Adults
  • Health Spending Will Grow Slightly Faster Under Reform Law: CMS Report
  • Health Insurance Exchanges Will Increase Employer-Sponsored Health Insurance Offers
  • Uninsured Numbers Rose in 2009
  • Many Consumer Benefits Under the Affordable Care Act Are Now in Effect
Compliance Concerns
  • Major New Patient Privacy Rules Proposed by HHS
  • RAC Inpatient Medical-Necessity Audit Focuses on Physician Orders
  • Medicare Contractors Seek Detailed Data; Providers May Disregard Some Requests
  • Global Approach to ‘Defense Audits’ Helps Inform Management, ID Errors
  • Problems Are Emerging with Double Dipping For E/M Services and Preventive Care
  • Reform Will Drive More Board Oversight of Compliance, Mean Fewer Conflicts for COs
  • Medicare Auditors Target Signature Rules After Finding ‘Significant Problems’
  • A Variety of Strategies Can Measure How Well Your Culture Supports Compliance
  • Physician Expenses Are at the Heart of False Claims Settlement Over Cost Reports
  • Productivity Compensation Keeps Employed MDs Motivated, But Creates Major Risks
  • Systems for Identifying, Reducing Risks Are Backbone of Compliance
  • The Top 10 Regulatory Risks for Hospitals
  • New CMS Rule Sets Stage for Use of New Program-Integrity Powers Under Reform
  • Audit of EHR Cloning Yields Documentation Problems That Put Compliance at Risk
  • Screening Medicare Providers by Risk
  • Protect your practice from providers excluded from Medicare and Medicaid


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