Practical HR Tips, News & Advice. Updated Daily.
A mandatory uniform standard for health plans to pay claims electronically was adopted in rules issued Jan. 5 by the U.S. Department of Health and Human Services (HHS). The rules are designed to help health care providers match payments received with the “remittance advice” transactions that plans are already sending them under an existing HHS […]
The feds’ decision to release Medicare claims data for quality measurement should help employers and individuals alike make more informed decisions down the road, advancing the goals of health care quality and value, a plan sponsor representative noted. Importantly, the Centers for Medicare and Medicaid Services’ (CMS) final rules apparently will allow the selected data […]
The effect of the Mental Health Parity and Addiction Equity Act (MHPAEA) on prior authorization practices and other “nonquantitative treatment limitations” was clarified Nov. 17 in guidance from the U.S. Department of Labor (DOL). The MHPAEA interim final rules issued in February 2010 imposed a detailed numerical formula for determining whether quantitative limits such as copayments […]
A wave of HIPAA privacy audits far more comprehensive than anything attempted to date was officially launched Nov. 8 by the U.S. Department of Health and Human Services (HHS). While their official purpose is not enforcement, these audits are likely to cast a broader net than HHS scrutiny has to date — including possibly group […]
Stop me if you’ve heard this one — a car is burglarized, and hardware goes missing that turns out to have sensitive personal data on thousands of beneficiaries, employees, patients and customers. Same old story — but in the millions this time. Medical information on nearly 5 million military clinic and hospital patients was on backup […]
Your company’s compliance officer — the person to whom you entrusted your confidential business information — alleges you wrongfully terminated her after she tried to prevent you from violating a federal law. This 8th Circuit opinion rules against the whistleblower in a case that is a fine example of internal breakdown handling a compliance complaint, and sparks […]
In the latest big-ticket enforcement action for alleged HIPAA privacy and security violations, the University of California at Los Angeles Health System (UCLAHS) has agreed to pay the U.S. Department of Health and Human Services (HHS) $865,500 to settle allegations the hospital violated HIPAA’s privacy and security rules. The settlement, announced July 7, resolves two […]
Your wellness program is going well, with happier and healthier employees. But then, an employee sues the company alleging that the wellness program violates his rights. So your employees are healthier, but your company’s pocketbook is not in the best of condition, as it puts out money for legal fees. Do not let this happen […]
A dreaded accounting-of-disclosure rule for electronic protected health information (ePHI) will require action by many employers, in their roles of health plan sponsors. (Employers are not technically “covered entities” under HIPAA privacy but, in effect, must comply if they’re involved in plan administration.) The rule came out in proposed form on May 31. It would […]
by Joseph C. Pettygrove The Family and Medical Leave Act (FMLA) was very complicated when it was originally enacted in 1993. The sheer number of complaints filed with the U.S. Department of Labor (DOL) and the courts since then confirms that employers and employees have long disagreed about how the law applies in their individual […]