Court decisions on ACA marketplace rules affect key coverage provisions
As CMS moves ahead with Medicaid funding limits for gender-affirming care in minors, Democratic state leaders used litigation to block restrictions in the Affordable Care Act (ACA) insurance marketplaces. The ACA policy, established in 2025 regulations, would remove the essential health benefit (EHB) designation from gender-affirming care. EHB status allows ACA consumer protections, such as…
Prevent denials by catching credentialing issues
Verifying the credentials of ordering physicians should be an essential part of revenue cycle management, and it could prove to be a fruitful endeavor. Ximena Restrepo, compliance and privacy partner for Billings Clinic–Logan Health, which serves residents of Montana and Wyoming, said Billings-Logan has saved thousands of dollars in avoided claim denials or in avoided…
Optimizing 340B participation compliantly while “waiting and watching” new developments
Since 1992, the 340B program has required drug manufacturers to provide eligible healthcare organizations and other covered entities with drugs to be used for these organizations’ outpatients at significantly reduced prices, with the intent of helping safety net organizations improve their financial stability. In turn, hospitals are expected to demonstrate that the savings they receive…
Legal and Regulatory Compliance
Keep up with the latest legal and regulatory developments and related subtopics of privacy and HIPAA, Medicaid and Medicare compliance, IRS matters, and the Red Flags Rule.