Major Themes of Health Care Reform for Providers, Part Two

Putting aside hotly contested issues such as the proper scope of federal authority and the cost of expanded coverage, the new law has pragmatic implications for health care providers in five broad areas that will affect provider activity in a number of different ways.  Today is Day Two of covering the major themes of health care reform for providers.

Various provisions of PPACA promote or require enhanced disclosure and transparency regarding hospitals, physicians, and other health care providers. These include:

  • Imposing new requirements on exempt hospitals to demonstrate responsiveness to community need and adherence to charitable mission
  • Modifying the Stark Law’s in-office ancillary services exception to require patient notification of alternative suppliers of enhanced diagnostic imaging services
  • Developing (by 2012) new systems to measure and report physician resource use, and directing release of Medicare claims data for purposes focusing on effectiveness and cost

Oversight, Responsibility, and Accountability
The PPCPA law further promotes enhanced provider responsibility and accountability through various means, including providing for provisional oversight of new service providers and suppliers through prepayment review and payment caps, and providing for exclusion of Medicare-terminated providers from Medicaid participation.

Enhanced Need for Attention to Regulatory Compliance
Several provisions have been retooled to promote compliance with existing laws regulating the delivery and reimbursement of health care. Supplemental measures include:

  • Imposing new duties on industry participants including special requirements on DME, home health, and certain other services, requiring refund of overpayments within 60 days, and mandating compliance programs
  • Expanding the National Practitioner Data Bank, and expanding and mandating data sharing to help ferret out fraud and abuse
  • Broadening the scope of false claims laws to delineate additional offenses and to establish additional funding to auditing and enforcement activities

In this week-long series, we will post five articles that will help you understand the primary areas targeted by new health care legislation so you can focus your efforts accordingly and position your organizations for the transformative changes that lie ahead.

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