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COVID-19 and Hospital Financial Performance
August 31st, 2020
KaufmanHall, a consulting services and software provider to 80 of the 100 largest health systems in the United States, recently published an article entitled, “The Effect of COVID-19 on Hospital Financial Health.”[1] “For any organization, a po…
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New Provider COVID-19 Reporting and Testing Requirements
August 31st, 2020
On August 25, 2020, the Centers for Medicare & Medicaid Services (CMS) promulgated regulatory changes via an interim final rule dated August 21, 2020,[1] requiring nursing homes to test staff and offer testing to residents for COVID-19. Laborator…
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The Time is Now for Reference-Based Pricing Plans
July 31st, 2020
As if the standard issues facing businesses related to healthcare were not enough, businesses now have to deal with the COVID-19 pandemic. As it was, annual premiums were on the rise – increasing 5% in 2019 and predicted to increase 6% in 2020.[1]…
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Section 1332 Waivers-Reinsurance
July 31st, 2020
Section 1332 of the Affordable Care Act (ACA) allows states to apply for a State Innovation Waiver to pursue innovative strategies for achieving high quality, affordable health insurance and to to alter key ACA requirements in the individual and smal…
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U.S. District Court Holds Department of Health and Human Services’ Price Transparency Rule is Constitutional
June 29th, 2020
In November 2019, the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services, issued a Rule entitled Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Ra…
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Looking for an Exit?
June 29th, 2020
Before the onset of COVID-19, there existed a seller’s market for businesses. Clean, profitable businesses were in short supply. An abundance of private equity and historically low interest rates drove multiples to levels this author had not previo…
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Surprise Medical Billing Statutes Ignore Fundamental Right
May 31st, 2020
Surprise medical billing has been a key issue targeted by legislators across the country, including by the U.S. House and Senate. Surprise medical bills arise when a patient inadvertently receives care from an out-of-network provider, such as when a…
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Balance Billing and COVID-19
May 31st, 2020
On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”). The CARES Act has many components, one of which was to make $175 billion in Provider Relief Funds available to hospital fac…
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Data and More Data; Good Data or Not so Good Data?
April 30th, 2020
Good reliable data is necessary for public authorities, aided by medical professionals, to formulate sound strategies for dealing with COVID-19. An understanding of the progression of the pandemic, infection rates, death rates, and other data points…
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Tossing Aside the Rule of Law, an "Op Ed" By James F. Koehler
April 30th, 2020
Are we tossing aside the rule of law as we respond to the COVID-19 pandemic? I’m beginning to wonder. I can’t help but think the state-by-state designations of essential businesses have been arbitrary, inconsistent, and in some instances driven b…
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