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OIG Reminds Healthcare Providers of Fraud Risk Factors When Deciding whether to Exclude a Healthcare Provider

With the continued proliferation of qui tam False Claims cases showing no signs of slowing down, not only must providers consider the amount of any monetary settlements, they must also consider whether the Office of Inspector General for the Department of Health & Human Services ("OIG") will require a corporate integrity agreement ("CIA").

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Alabama Hospital Association Campaigns to Expand Medicaid in Alabama
Alabama Hospital Association Campaigns to Expand Medicaid in Alabama

The Alabama Hospital Association has launched the ALhealthmatters campaign, highlighting the importance of expanding Medicaid in Alabama.

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What Anthem's Historic $16 million HIPAA Settlement Means for Providers

The Department of Health and Human Services $16 million HIPAA settlement with Anthem, Inc. following its investigation of the equally historic 2014 breach affecting almost 79 million people. Is this an enforcement trend?

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Cyber-Incident---Now What?
Cyber-Incident---Now What?

In this day and age, where a vast amount of information is stored electronically and you can buy almost anything with a "one-click" purchase, it comes as no surprise that cyber-incidents are on the rise, especially among healthcare providers.

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CMS Proposes Accelerated Shift to Provider Risk in ACOs

To facilitate the American healthcare system's transformation from volume-based to value-based payment, CMS is requesting public comment regarding its newly proposed rule that would shift the amount of risk that participants in Accountable Care Organizations (ACOs) assume under the Medicare Shared Savings Program (MSSP).

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New Pathways to Success for ACOs
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Wading into the Pool of Risk Bearing Reimbursement Models

Many Alabama providers participated in the Quality Payment Program in 2017, under MIPS (Merit Based Incentive Program). A handful participated in a MIPS APM (Alternative Payment Model), which is a baby step towards alternative payments, but still left the participants free from downside risks.

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UAB Physician Develops Novel Node Surgery for Melanoma
UAB Physician Develops Novel Node Surgery for Melanoma

Sunlight provides the energy that powers all life on earth. However, those radiant waves also have a darker side. They are a leading suspect in cellular changes that lead to melanoma, a cancer that can rapidly become lethal as it moves into surrounding lymph nodes and beyond.

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Opportunities and Warnings about Reimbursements
Opportunities and Warnings about Reimbursements

"We have a problem with patients disregarding their medical provider, and that shows in many ways," says Maddox Casey, CPA, MBA, with Warren Averett healthcare division.

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Rural Reimbursements
Rural Reimbursements

Only 4,177 rural health clinics (RHCs) exist in the entire U.S. A little over one hundred of those reside in Alabama.

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Updating the Way to Pay
Updating the Way to Pay

CMS is proposing big changes in the physician fee schedule and quality payment program for 2019

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U.S. House Passes Bill To Improve Workforce Development In Palliative Care

On July 23, 2018 the United States House of Representatives passed HR 1676 approving grants to improve educational programs, research and workforce development in palliative medicine.

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Association Health Plans: A Potential Solution for Small Business

In an effort to provide more options in the insurance marketplace, the Trump Administration is making it easier for small businesses to form association health plans. These plans allow multiple small employers to band together to provide health insurance for their employees. By purchasing or providing insurance through an association, small businesses can take advantage of the leverage and economies of scale usually reserved for larger groups.

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Technology Boosts Patient Engagement and Savings
Technology Boosts Patient Engagement and Savings

"We have 17 providers, but only four phone operators, all because of our patient portal," says Clay Barnett, director of internal programs at Birmingham Internal Medicine Associates (BIMA). This tech allowed them to add four physicians in the last two years without the expense of hiring any additional phone support.

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Stolen PHI Records Have a New Market
Stolen PHI Records Have a New Market

The days of stealing personal information for credit cards no longer holds the greatest appeal for hackers of medical facilities. "Credit card companies stand behind their clients," says Russ Dorsey, manager of information services at Kassouf & Co. Purchases are rapidly questioned, cards are voided, and card holders rarely get dinged.

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Betting on Blockchain
Betting on Blockchain

Improved efficiency and communication are at the heart of blockchain technology, offering great promise for the healthcare industry to realize improved outcomes in both a business and clinical setting.

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Building Boom for UAB Medicine
Building Boom for UAB Medicine

Girders, cranes, and concrete are a familiar sight around UAB, especially now with three new construction projects underway on the medical side alone.

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Understanding Total Cost of Occupancy
Understanding Total Cost of Occupancy

There are many questions to consider when determining where to locate or move a practice.

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Escobar Materiality Requirement Wipes Out $347 Million Jury Verdict in False Claims Act Case

In 2016, the United States Supreme Court issued its decision in Universal Health Servs. v. U.S. ex rel. Escobar which dealt, in part, with how the "materiality" requirement should be enforced in False Claims Act ("FCA") cases.

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European Union's General Data Protection Regulation
European Union's General Data Protection Regulation

You may have heard a lot lately about GDPR lately and thought "Why should I care? It probably won't affect me or my business."

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Alabama Caught in the Mire of the Hospital Wage Index
Alabama Caught in the Mire of the Hospital Wage Index

"The methodology was flawed to begin with," says Danne Howard, chief policy officer with Alabama Hospital Association (AlaHA), about Medicare's method for calculating the reimbursement rate for hospitals, especially rural facilities. "But it's become even worse."

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The Alabama Data Breach Notification Act of 2018

On June 1, 2018, any person or business that acquires or uses personally identifiable information of an Alabama resident, or contracts to maintain, store, process or access such information, may be subject to The Alabama Data Breach Notification Act of 2018.

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Staying Focused on Practice Business Strategy

I recently attended a conference in Las Vegas where I caught up with colleagues who specialize in healthcare operations and business strategy.

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Can I Waive a Patient's Co-Pay?
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Searching for Sustainable Solutions to the Physician Shortage
Searching for Sustainable Solutions to the Physician Shortage

AAMC calls for a multi-pronged approach to address the looming physician shortage.

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