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, and Medicare…
Hospice Care for Medicare Medicaid Tricare Beneficiaries
Hospice Nursing Labor Shortages, Quality Measures Reporting, and Aggregate Cap Calculations Create Hospice Reimbursement Conundrum DISCLAIMER This Compliance Guidance has been gathered and interpreted by No World Borders from various…
HIPAA and HITECH Act Serve as Cybersecurity Recognized Security Practices
On December 24, 2020 the Senate passed new legislation H.R.7898 - "To amend the Health Information Technology for Economic and Clinical Health Act (HITECH Act) to require the Secretary of…
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, Medicare 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 Money to convert from paper to electronic People who ask, "What is the HITECH Act?" should understand how the Act…
Suicide Prevention Lifeline
World Suicide Prevention During COVID-19 Pandemic Requires Empathy and Outreach
September 10th 2020 is World Suicide Prevention Day. CDC data indicates that suicide and suicidal ideation is higher in men aged 18-24, essential workers, blacks, and Hispanics who never graduated…
Inpatient rehabilitation facility and Medicare Coverage determinations
Medicare Inpatient rehabilitation facility (IRF) Coverage
Medicare Inpatient Rehabilitation Facility (IRF) Coverage Medicare Part A (Hospital Insurance) covers medically necessary care that insured patients receive in an inpatient rehabilitation facility or unit (‘ inpatient ‘rehab facility, IRF, acute care…
COVID-19 testing directories are maintained by U.S. HHS
COVID-19 Testing and Diagnosis Codes and your EHR
CPT Test Procedure Codes for COVID-19 Testing COVID-19 testing and diagnosis codes are an essential component to collecting and analyzing data to understand the pandemic. U.S. Health and Human Services…
Home Health Care Attendant Care Respite Care
Home Health, Attendant Care, Respite Care Coverage, Coding and Billing Federal Medicare Home Health Care PPS Dates to Balanced Budget Act of 1997 The 1997 Balanced Budget Act (BBA), amended…