Medicare Part B Overview
1. What is Medicare Part B is and what does it cover? Medicare is health insurance for: People 65 or older Under 65 with certain disabilities People of any age…
Pandemic Police Powers of a State Should be Least Restrictive
During the pandemic, when an American citizen domiciled in a state is deprived of civil rights by the state, was the deprivation of civil rights done appropriately according to the…
Examples of formulary exclusions (removals) and updates
Formularies and PBMS
What Is a Formulary? In its simplest form, a formulary is a list A drug formulary is a preferred drug list. The list of medications on the formulary changes based…
NSA Provides Guidance to Mitigate VPN Vulnerabilities to Hackers
In October 2020 and April 2021, the U.S. National Security Administration posted advisories regarding known vulnerabilities that Chinese and Russian hackers use to breach U.S. and other networks. Our Observations:…
Esoteric Testing Market Segments
Esoteric Testing Market Segments The esoteric testing market segments can be seen in their simplest form in two areas: chemiluminescence immunoassay enzyme-linked immunosorbent assay radioimmunoassay, mass spectrometry, flow cytometry, real-time…
Requiring Employees to be Tested for Infectious Disease
Employer Required COVID-19 tests for employees, According to the Americans with Disabilities Act, and EEOC Laws According to the U.S. Equal Employment Opportunity Commission: An employer may administer a COVID-19…
Do Risk Corridors Help Health Plan Beneficiaries?
The Supreme Court found that the U.S. Government breached a commitment to Pay $12 Billion to Health Insurers, but are these payments going to help beneficiaries? Introduction The U.S. Supreme…
How do Pharmacy Benefit Managers Determine Pricing?
This is a complex subject—first, some introductory concepts. Then, the details. In healthcare, the intersection of demand, price, quality, and suppliers' sources alone does not determine whether pricing is appropriate.[i]…
Use of Telemedicine During a Public Health Emergency
Use of Telemedicine During a Public Health Emergency DISCLAIMER This information and compliance guidance has been gathered and interpreted by No World Borders from various resources including CMS, Medicare Administrative…
Provider Based Facilities Integration
Under Medicare, payments for services performed in provider-based facilities may be fifty (50) percent higher than payments for the same services performed in a freestanding facility. This increased cost is…
Medicare Appeals
Five Types of Medicare Appeals in Part B There are five types of Medicare Appeals. The process differs slightly for Medicare Part A, Medicare Part B fee for service, Medicare…
What is the HITECH Act? New developments since 2009 including the ACA of 2010, HIPAA Omnibus of 2013, MACRA of 2015 and 21st Century CURES Act of 2016
What is the HITECH Act? Introduction for the Novice
What is the HITECH Act? An Introduction for the Layperson People who ask, "what is the HITECH Act?" want to understand how the Act impacts electronic health record use, privacy,…
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