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NJ Out-of-Network Consumer Protection Bill Spurs Opposition from Healthcare Providers

Recently, a group of New Jersey lawmakers introduced Bill A-4444 in the Senate proposing to codify the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Act”). The Act’s goal is to increase transparency in pricing for health care services and contain rising costs, as out-of-network coverage charges have been steadily exposing consumers to additional costs. In an effort to more efficiently transform the healthcare system, lawmakers are proposing...

Chronic Care Management: Revenue for Physicians, Improved Care for Patients

Chronic Care Management reduces the total cost of care for chronic disease patients while improving their overall health. In the 2015 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare & Medicaid Services ("Medicare") acknowledged a provider's ability to engage in non-traditional methods of assessing patients for chronic pain, effectively opening the door to payments for chronic care management (CCM). CCM services are non-face-to-face medical care services that can...

Resurgence of the House Call

Nowadays, it seems as though everything, from grocery shopping to banking, can be done online, and it appears that the practice of medicine is the next field poised for redevelopment by way of digital technology. Several new web and mobile device applications have recently been developed, launching location-based platforms for physician house call services. These services are predicated on convenience, and connect physicians and patients instantaneously and in real time,...

Are Insurance Carriers In Trouble? Why Should You Care?

As the Affordable Care Act (ACA) continues to influence and change the healthcare landscape, innovation in the method of delivery of healthcare is at the forefront of the shifting dynamic between healthcare providers, insurance carriers and patients. The ACA has paved the way for healthcare systems to expand their roles beyond simply providing healthcare to patients, and one manner in which this is occurring is the development of self-funded insurance...

Medicare Benefit Policy Manual Updated to Permit Payment for Physical Therapy, Nursing Care and Other Services

In January 2014, the Center for Medicare & Medicaid Services (CMS) updated its Medicare Benefit Policy Manual (“Policy Manual”) to reflect a change whereby Medicare will now compensate Medicare beneficiaries for certain skilled care, including physical therapy, nursing care, and other such services, without taking into account the patient’s likelihood of improvement or prognosis of a chronic disease. The clarification in policy will affect care provided by skilled care professionals...