American Health Care Act DOA. What Does it Mean for Medical Cost Litigation?
Paul Ryan failed to marshall enough Republicans to vote for the American Health Care Act

American Health Care Act DOA. What Does it Mean for Medical Cost Litigation?

American Health Care Act supporters, such as Paul Ryan, had to acknowledge that the Act was dead on arrival Friday.  Despite the fact that the Trump Administration presides over a…

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Expert Witness Medicaid Expansion Affordable Care Act

As an expert witness I am regularly requested to provide opinions regarding the value of medical care under the Affordable Care Act. A misunderstood and often overlooked centerpiece of the Patient Protection and Affordable Care Act—often referred to as “Obamacare” or "ACA"—is the expansion of Medicaid eligibility to people with annual incomes below 138 percent of the federal poverty level.

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Affordable Care Act Expert Witness Work Requires Attorney Education

In my work as an expert witness regarding the Patient Protection and Affordable Care Act (also known as the "ACA" or "Obamacare"), I find that more medical malpractice and personal industry cases as well as cases involving requirements for insurance coverage for self-insured employer's employees encompass ACA in their scope. The ACA may change the economics of healthcare as they apply to a legal matter involving damages, value of care, or insurance coverage and benefits.

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Employer Deadlines for Insurance Under the Affordable Care Act Extended by IRS

The deadline for employers to electronically file the so-called 1094 forms for 2015 which provide coverage information to the IRS was extended to June 30, 2016 from March 31, while non-electronic form reporting was delayed to May 31, 2016 from Feb. 29.

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Healthcare Expert witness, HIPAA, HITECH Act, Medical Coding and Affordable Care Act Considerations

healthcare expert witness work in medical coding and billing, usual customary and reasonable cost of care, HIPAA Privacy, HITECH Act, and Affordable Care act require special considerations

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Inpatient Psychiatric Facilities Impacted by Affordable Care Act, ICD-10

Section 1886(s)(4)(C) of the Social Security Act, amended by sections 3401(f) and 10322(a) of the Affordable Care Act requires IPFs to report quality data for 6 quality measures starting in fiscal 2013 for Medicare beneficiaries. Beginning in FY 2015, two quality measures are added. Why does this matter in the context of ICD-10? The quality measures will be based on diagnosis and procedures coded in ICD-10 beginning October 1, 2015.

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Value Based Care Regulations Yield Physician Discontent, No Change in Behavior

Clinicians are in a knowledge management crisis – massive amounts of data but getting the right information to clinicians, IT personnel and others at the right time is the challenge. What was missing from the RAND report were biomedical informatics perspectives.

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Will Healthcare Go the Way of Farming in the U.S.?

a focus on income support has remained constant. We can assume that based on recent U.S. policy certain incentives and regulations will continue in healthcare and that the general effect will be to encourage scale and specialization. The main difference between healthcare and agriculture is that interoperability is essential for the former and will create cooperatives focused on data sharing just as in agriculture smaller providers have historically joined forces to achieve economies of scale and reduce redundant processes.

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Hospital Readmissions Penalties Interactive Table

Update August 2, 2013 - CMS published a list of 2,225 hospitals in 49 states that will lose up to 2% of their Medicare reimbursement that had too many patient readmission within 30 days of discharge because of three medical conditions: heart attack, heart failure and pneumonia. Under the PPACA, the maximum penalty will increase to 3% by 2015 and expand to include re-admissions for other medical conditions. ICD-10, a standard the describes the condition of the patient, will modify these quality measures when it goes into effect. We have published an interactive, searchable version of the penalties, by city, state, county and hospital for the healthcare industry and consumers to use to easily find the data relevant to their geography or organization.

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Out of Network Claims Market Gets More Interesting: Cedars-Sinai, UCLA Dropped by Anthem

Out of Network Claims Explained One of the most significant inefficiencies in health care is the pricing strategy of health plans regarding their policy on reimbursement for members who receive…

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Accountable Care Organizations and Medicaid

Accountable Care standards may be fluid for some time, however it is clear that there will be a need for core competencies in population management, coordination of care and other areas for an ACO to function effectively. Blum emphasized that CMS will be looking for innovative models, with different payment systems, and with different “on ramps” to formation and approval. It was also acknowledged that improving quality and reducing cost through coordination of care will at times be at odds with and the Accountable Care Act’s continued focus on patient choice of providers.

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