As promised, the Centers for Medicare and Medicaid Services released information about Medicare payment to physicians and certain health care professionals on April 9^th. The release is in conjunction with the policy change instituted by the U.S. Department of Health and Human Services, which allows CMS to respond on a case-by-case basis to Freedom of Information Act requests for Medicare payment information related to individual physicians (see more on the topic here).

Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems. Nine states currently have APCDs in place, but Kentucky is not one of them. These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs?

Over the last decade, many states have established all-payer claims database (“APCD”) systems that collect medical, pharmaceutical, and dental eligibility and claims information. Payers, including insurance providers, third-party administrators, prescription drug plans, Medicaid, and Medicare, are responsible for depositing eligibility and claims data into a collective system. The data can then be used to generate important information about cost and quality of care. By gathering detailed information in one place, a statewide picture emerges – information on service providers, patient demographics, and other important healthcare data.

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”).