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Under fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous admission of drugs or biologicals to an individual at home. The quarterly average of HIT service visits was about 7,500 from 2021 to 2023, according to the Centers for Medicare & Medicaid Services (CMS).
However, providers need to be sure they’re not running afoul of the federal laws, or the state law equivalents, that regulate the financial relationships between agencies and their referral sources. Providers that violate these laws can be excluded from participating in federal health care programs, such as Medicare and Medicaid.
Extensive Program Support: Handles commercial, Medicaid, Medicare, Tricare, and more. We understand that navigating complex stakeholder relationships and evolving healthcare regulations requires more from a cost management partner than strictly managing cost,” said Jay Deady, President of Price Optimization for Zelis.
This model legislation limits out-of-network rates for inpatient and outpatient hospital services to the lesser of (a) the state’s median in-network commercial rate for the same service; or (b) [X]% of the Medicare rate for the same service in the same geographic area. X]% of the amount paid by Medicare for the same item or service; or.
And as you know, obviously a huge percentage of healthcare spending is funded through Medicare, Medicaid, Tricare, the VA system, and these are all programs that are covered by the False Claims Act. It’s a highly regulated industry. So there’s that instinctual resistance to it. That you have to deal with compliance.
Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. . “Their model is to deliver short-term financial goals and in order to do that you have to cut corners,” said Mary Inman, an attorney who represents whistleblowers.
Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. . “Their model is to deliver short-term financial goals and in order to do that you have to cut corners,” said Mary Inman, an attorney who represents whistleblowers.
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