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Federal Court Blocks Anthem-Cigna and Aetna-Humana Merger!
On April 28, the U.S. Court of Appeals for the District of Columbia upheld a federal court ruling that blocked the proposed merger of the two health insurance giants Anthem and Cigna.
On February 8, the U.S. District Court for the District of Columbia issued a ruling that blocked the proposed merger of the two health insurance giants Anthem and Cigna.
MSMA strongly objected to the mergers at both the state and federal level, citing the unhealthy concentration of market power the newly-combined entity would have. MSMA, the AMA, and others loudly warned that the resulting anti-competitive insurance environment would be harmful to the public, with higher premiums, greater out-of-pocket costs, narrow provider networks, and reduced access to care.
The court, siding with the U.S. Department of Justice which filed the lawsuit against the proposal, found that the merger would have worsened an already highly-concentrated market, and likely would have raised prices. The court also found that Anthem did not defend its allegation that “all providers, no matter their size, location, or financial structure, are operating at comfortable margins well above their costs.”
This is an important victory for physicians and their patients, and comes on the heels of an equally significant court ruling in January that blocked a similar merger between Aetna and Humana. Don’t let them tell you organized medicine doesn’t do anything for you.
Fees for Medical Records Effective 2/1/17
The new maximum fees for copying medical records will be $24.85 plus $0.57 per page for the cost of labor and supplies for copies provided in paper form, and $23.26 for additional costs if records are maintained off-site. The new maximum fees for copies provided electronically will be $24.85 plus $0.57 per page, or $108.88 total, whichever is less. For more information, go to: http://health.mo.gov/atoz/fees.php.
HIPAA and Fees for Medical Records
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a covered entity may only charge an individual or the individual’s personal representative a reasonable cost-based fee. The Office for Civil Rights has posted guidance regarding what a covered entity provider may charge an individual or the individual’s personal representative here.
Medicare Fraud Alert
If you receive a request for a signature on a Certificate of Medical Necessity for a patient not known to you, the physician area already completed, or if you receive a request for medical record documentation for a patient where you did not order the DME item, or that you do not believe is appropriate for the patient, please treat this as a fraud issue.
You can submit the information to OIG Hotline: 800-HHS-TIPS (1-800-447-8477) or online at https://forms.oig.hhs.gov/hotlineoperations/
CMS issues final MACRA Quality Payment Program rule
The Department of Health and Human Services issued its final rule to implement the Quality Payment Program (QPP) which was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace the flawed Sustainable Growth Rate formula for updating the Medicare physician fee schedule.
The final rule – a tortuous 2,205-page manifesto and alphabet soup of federal acronyms – sets forth two main options for participating physician practices to consider: The Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs)....read more.