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Healthcare Organizations and Entity Types: What You Need to Know About Benefit Corporations

When deciding on an entity type for a healthcare organization, including physician practices and specialty groups like oncology practices, many different aspects of the organization should be taken into consideration, including funding, taxability, profit distribution to owners, social objective/non-profit mission, and limitation on activities, among others. One option, incorporating as a benefit corporation, may legally protect an organization's goals by creating accountability towards the organization's social and environmental commitments. Benefit...

CLIENT ALERT: Compliance with New Jersey’s New Out-of-Network Law

On June 1, 2018, New Jersey Governor Phil Murphy signed the "Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act" into law.  The law contains a number of provisions which will have a serious impact on all licensed New Jersey healthcare providers, as well as healthcare facilities such as Ambulatory Surgical Centers (ASCs). Many medical practices and healthcare facilities have excellent internal controls ensuring that patients understand their financial commitments,...

New CMS Final Rule Adds Non-Skilled In-Home Care as Medicare Advantage Benefit in 2019

The Centers for Medicare & Medicaid Services (CMS) recently announced a final rule allowing Non-skilled in-home care services as a supplemental benefit for Medicare Advantage (MA) plans in 2019. This is first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage. The announcement is a part of CMS' expanded definition of "primarily health related," which allows supplemental benefits if they compensate for physical impairments, diminish the...

Why Providers Need to Carefully Negotiate the Complex Payment and Penalty Provisions Under Shared Savings Agreements

 "Shared savings agreements" or "physician incentive plans" are agreements between provider groups and carriers or the government wherein bonus payments are paid, or penalties assessed, pursuant to a contractually agreed upon formula designed to measure quality-based performance over a given time period. As these relatively new agreements can be highly technical and the mechanics of the bonus calculation quite opaque (often by design), provider groups tend to take the bonus...

Physician Integration Models: CINs, MSOs and Integrated Group Practices

This article originally appeared in Viewpoint Magazine published by The Verden Group. Republished with permission. Although much is changing in the way healthcare is delivered - from MACRA to ACOs to private equity practice roll-ups to insurance company-owned practices to hospital-owned practices – one thing hasn’t changed: physicians are still the only participants in the healthcare system that actually treat patients (in addition to their mid-level counterparts). Although there may...