Healthcare Law & Policy Archive

NJ DOBI Orders Aetna to Properly Reimburse Non-participating Providers

Last week, the New Jersey Department of Banking and Insurance (“NJ DOBI”) entered an order requiring Aetna to pay a fine of $9,457,500 for violating New Jersey’s HMO regulations regarding reimbursement for services rendered by non-participating providers. New Jersey HMO Law Pursuant to New Jersey law, an HMO must limit its members’ liability for services

Compliance Update – Providers and the Pharmaceutical Industry

Regulators are increasingly focusing on the propriety of certain relationships and interactions between health care providers and the pharmaceutical industry. Since this issue is on the minds of many providers, I am including below an article I recently wrote for Florida Medical Business Journal, the region’s leading medical business publication. Avoiding Dangerous Medicine Developing an

Why utilize ERAs and EFTs?

A provider recently asked me whether she should register to receive Electronic Funds Transfer (“EFT”) and Electronic Remittance Advice (“ERA”) for her Medicare Part B claims. I answered “yes” and also encouraged her to consider registering for EFT and ERA with regard to any other payers with whom she participates. Since so many providers have

Practicing Preventive Legal Medicine

I am including below excerpts from an article I recently had published in Florida Medical Business Journal, Florida’s leading medical business journal. I apologize in advance to those who practice outside of Florida; however, most of the principles discussed in this article are applicable to doctors practicing in any state with the United States. Practicing

Hospitals Consider Discounts for Needy Patients as Costs Soar

Major medical technology advances over the last two decades have significantly improved the quality of care received by hospital patients. However, the use of technology has also resulted in increased costs and many of the underinsured or uninsured ‘working/retired poor’ have been priced out of the market. In a recent RAND Health report, Dana Goldman,

Drafting and Using Enforceable Non-Compete Agreements

I am including below an article I recently had published in Florida Medical Business Journal, Florida’s leading medical business journal. I apologize in advance to those who practice outside of Florida. Nevertheless, the principles of Florida law are very similar to those in most of states; therefore, I encourage non-Florida employers and employees to read

How to Earn Your PQRI Bonus

My last two blogs addressed the ‘what’, ‘when’ and ‘why’ aspects of PQRI (if you haven’t yet read them, you may want to do so prior to reading today’s blog). Today’s blog focuses on the issue of how a health care provider can obtain a PQRI bonus. You are not required to formally register in

Now is the Time to Get Ready for PQRI

As of July 1, 2007, providers must begin reporting information regarding certain quality measures (I’ll describe this in greater detail tomorrow). While the official kickoff for reporting activities is still months away, NOW is the time to make certain that you will be ready. If you are using an EMR, your new reporting responsibilities will

Medicare PQRI Deadline Approaches

As we approach the July 1, 2007 deadline, health care providers are increasingly asking about the details associated with Medicare’s Physician Quality Reporting Initiative (“PQRI”). My next few blogs will address some of the questions I have been asked by providers. Many providers are simply asking “what is PQRI?” PQRI is an initiative created by

CMS Relaxes NPI Deadline

The Centers for Medicare & Medicaid Services (CMS) has just announced that it is relaxing the enforcement of its May 23, 2007 deadline concerning the mandatory use of the National Provider Identifier (“NPI”) in conjunction with all standard transactions. Section 1173(b) of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) set into motion