The DOL released Frequently Asked Questions on September 20, 2010 which address several open questions on health care reform: For adult child coverage requirements, we’ve received many questions about the definition of child. This guidance answers some of those questions. A plan will not fail to satisfy the …
Signature Requirements for Orders May Result in Denied Payment
September 21, 2010 Leave a Comment
CMS’ Change Request 6698 for the Medicare Program Integrity Manual clarifies how Medicare claim contractors review authentication of certain orders and supporting medical documentation. This transmittal applies to claim reviews performed by Medicare Administrative Contractors (MACs), Comprehensive Error Rate …
Scope of “Adult Child” Coverage Requirements
September 16, 2010 Leave a Comment
Group health plans that offer dependent child coverage will soon have to make coverage available for adult children who are under age 26. As employers prepare for annual enrollment, many are curious about whether this new mandate applies exclusively to medical programs, or extends to dental and vision programs as …
Another OIG Opinion Calms Fears Government May Punish Charities Helping Poor People Dying From Brain Tumors
September 15, 2010 Leave a Comment
At first blush, the conclusion seems obvious. But OIG Advisory Opinion 10-12 reminds us that calling something “charity” doesn’t immunize it from careful scrutiny under the fraud and abuse laws. This opinion, released August 30, is the latest of several OIG opinions addressing patient assistance programs, or …
New Horizontal Merger Guidelines and Health Care Reform
September 14, 2010 Leave a Comment
Apart from other impacts, the Patient Protection and Affordable Care Act (PPACA) will likely spur health care consolidation involving many hospitals, physicians and other industry stakeholders. Regardless of the form of combination pursued, antitrust compliance variables—including post-closing market …
Can Employers Purchase Coverage in the State-Based Exchanges in 2014?
September 13, 2010 Leave a Comment
It depends on the size of the employer. By January 1, 2014, each state must create a state-based health insurance Exchange that allows individuals and small businesses to purchase health insurance coverage. A small business is generally defined as one with 100 or fewer employees, but states may choose to …