The Texas Department of Insurance – Division of Workers’ Compensation (TDI-DWC) recently announced that it will begin its plan-based audit of compound medications filled during the time period of September 1, 2014 to August 31, 2015. TDI-DWC indicated that the audit is designed to ensure that physicians adhere to the “medically accepted standards of care…
HB 574 passed out of the 2015 Texas Legislature and prevents commercial insurance carriers from delisting a physician from its network as a result of the physician referring a patient to an out-of-network provider or facility. Click here to read the legislative summary of HB 574. The Texas Department of Insurance (TDI) recently reminded insurance carriers…
Dear TOA Member: TOA’s April 28, 2016 eConnect contained preliminary details regarding Medicare’s MACRA proposed rule, which replaces the Medicare SGR physician payment program. We will continue to provide more information as analysis becomes available. Click here to view the American Association of Orthopaedic Executives’ initial summary of the proposal. It includes a link to…
Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule to implement MACRA (Medicare Access & Chip Reauthorization Act), which Congress passed last spring to replace the SGR method for Medicare physician payments. The following graphic from the American Academy of Orthopaedic Surgeons (AAOS) shows the two paths to incentives in the…
Lost in the mix of CMS’s MACRA proposed rule was CMS’s proposed rule the Medicare hospital inpatient payment proposal for 2017 earlier this month. The future of Two-Midnight cuts was the biggest story out of the inpatient proposal – click here to read more from AAOS. Click here for an overview of the musculoskeletal issues…
One of the core functions of CMS has always been to drive quality improvement through the use of voluntary reporting programs, such as the Physician Quality Reporting System (PQRS). Originally established under the Tax Relief and Health Care Act of 2006 (TRHCA), the program provides financial incentives to eligible providers who successfully report quality data…
Last week, the Texas House Insurance Committee examined the state’s prompt pay system. At issue is a strong move by the Texas Association of Health Plans (TAHP) to change the state’s current penalty payment methodology, which is currently based on billed changes, to a new system that would based on an interest rate system. The…
By Jason McCormick Even though the attestation period for 2015 Meaningful Use reporting will not be complete for the next several days, many orthopaedic practices are already looking ahead to determine which program objectives will be difficult to meet in 2016. It should come as no surprise that most orthopaedic providers have not been as…
