The Affordable Care Act (“ACA”) took a big leap forward this month with the opening of the federally-facilitated and state-operated Exchanges. Here in Kentucky, 70,467 people reportedly participated in pre-screenings to determine qualifications for subsidies, discounts, or programs like Medicaid on the Health Insurance Exchange’s first enrollment day, October 1, 2013. The ACA is eventually expected to provide health coverage to as many as 30 million additional Americans. So, why are hospitals across the nation slashing jobs?

Earlier this week, we discussed the three-month grace period afforded to enrollees of qualified health plans (“QHPs”). To recap that article, the ACA requires that QHPs pay claims for the first thirty days of the grace period during which premium payment remains unpaid, but issuers may pend claims for the final sixty days of the grace period. If the balance remains unpaid, the issuer may deny any claims submitted within the final sixty days.

Providers contracting with state health insurance exchanges may find themselves shortchanged for services provided due to a little-known loophole in the Affordable Care Act (“ACA”).

Earlier this week, I discussed CMS’ final rule on the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. The final rule provides guidance to physicians on how to designate a patient as inpatient or outpatient and the impact of the designation on Medicare Part A or Part B coverage. This blog will discuss the two midnight rule.

In August, the Centers for Medicare and Medicaid Services (“CMS”) announced a final rule regarding the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. This rule becomes effective on October 1, 2013.

A recent HIPAA settlement serves as an important reminder that protected health information (PHI) may be stored on “ordinary” office equipment such as printers, photocopiers, scanners and fax machines, and not just on computer hard drives.  On August 14, 2013, the Department of Health and Human Services (HHS) announced a settlement with the not-for-profit managed care plan Affinity Health Plan, Inc. (“Affinity”) for over $1.2 million in connection with HIPAA Privacy and Security breaches stemming from PHI stored on a photocopier hard drive.

It is no surprise that, given the current health care climate, providers who were unregulated just a few years ago are now subject to certification and licensure requirements.

In 2012, thirty-two organizations were selected to participate as “Pioneers” in a pilot Accountable Care Organization (“ACO”) program created through the Affordable Care Act (“ACA”).  The program’s goals were to revolutionize the health system and reduce medical costs by basing physician and hospital pay on quality rather than quantity.

Health care businesses are subject to complex rules and regulations, most of which are constantly changing. Providers of all types and sizes continually face licensure issues and compliance requirements. There are few industries as regulated as health care, but that is not to say that providers stand alone in the issues they face. In fact, one type of industry has a markedly similar oversight process: daycare centers.

There has been a surge of nursing lawsuits in recent years, with nurses arguing they have been denied overtime pay, meal breaks, and fair wages as guaranteed to them by the Fair Labor Standards Act (“FLSA”). The FLSA makes a distinction between exempt and non-exempt employees, with the latter receiving overtime and wage protection.