Appealing Readmission Denials For Medicare Eligible Patients
Medicare’s Hospital Readmissions Reduction Program (HRRP) requires payments to hospitals with excess readmissions to be reduced by a calculated factor, as an incentive for hospitals to implement strategies to reduce the number of preventable readmissions. The Medicare regulations set forth in Title 42, Sections 412.150-412.154 of the Code of Federal Regulations sets forth the methodology […]
The No Surprises Act: What To Watch Out For
The federal No Surprises Act became effective on January 1, 2022. This Act provides protections for patients against surprise medical bills from doctors, hospitals, and air ambulances for out-of-network emergency care and for care provided by out-of-network providers at in-network facilities. First and foremost, the No Surprises Act requires the payer plan or issuer to […]
The Federal “No Surprises Act” Arrives January 1, 2022
The Consolidated Appropriations Act 2021 was signed into law on December 27, 2020(“COVID Relief Bill”). The “No Surprises Act” contained therein specifies that patients willonly be required to pay in-network cost sharing amounts for out-of-network emergency care andcare provided from out-of-network providers at in-network facilities without the patient’sinformed consent. Many of the sections of the […]
Pennsylvania’s Workers’ Compensation Does Not Apply To The Railroads
Providers, hospitals and physicians, are very familiar with submitting claims under state workers’ compensation laws, such as The Pennsylvania Workers’ Compensation Act. But, there are some injuries and conditions affecting groups of employees that are not covered by those state laws. One example is railroad workers. Their work-related injuries fall under a federal law called […]
Recent Trends In Erisa
Out of network self-funded employer ERISA plans are paying Medicare based fee schedules for patients not on Medicare Within the last year or two, self-funded employer ERISA health plans who opted not to pay a premium and purchase health insurance for their employees from insurers who contract with health care providers; opted not to contract directly […]
