New Louisiana Hospital Medicaid Directed Payments — How Do You Get Paid?

Louisiana Medicaid is implementing directed payments for acute, psychiatric, LTAC, and rehabilitation hospitals through its five Medicaid managed care plans. The program covers services on and after July 1, 2022. Although no new hospital-MCO contracts are required, each plan has specific informational requirements. As a service to our clients and other Louisiana hospitals, Breazeale, Sachse & Wilson has compiled all of those forms and instructions on a single website.

Written by Gregory D. Frost

OCR Settles Three Cases with Dental Practices for Patient Right of Access under HIPAA

Last month, the Office of Civil Rights announced three settlements with dental practices involving patient requests for copies of medical records.  OCR noted in its press release that “these … actions send an important message to dental practices of all sizes that are covered by the HIPAA Rules.”

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Can a provider charge a medical records requestor a fee when there are no records? 

Can a provider charge a medical records requestor a fee when there are no records? There is no clear answer to this question.

A client was served with a subpoena for medical records, but the patient in question did not have a record (i.e., had not been a patient). The provider’s ROI company responded with a letter stating that there was no patient and invoiced for a processing fee and postage. The lawyer responded that the fee was illegal under the section of R.S. 40:1165.1 which states that “the health care provider … shall not charge any other fee which is not specifically authorized by the provisions of this Subparagraph…” 

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CMS Issues New  No Surprises Act FAQS on Good Faith Estimates and the Overall Requirements and Exceptions for Healthcare Providers

On April 6, 2022, the Centers for Medicare & Medicaid Services (CMS) issued two new Frequently Asked Questions (FAQs) guidance documents on the requirements of the No Surprises Act (NSA) that addressed a provider’s obligation to provide a Good Faith Estimate for uninsured and self-pay patients, and certain NSA requirements and exceptions.  CMS also announced plans to launch an online portal through which uninsured and self-pay patients may initiate the Independent Dispute Resolution Process.

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Due to the air ambulance market that frequently results in surprise bills, the U.S. Department of Health and Human Services (HHS) announced a proposed rule that requires plans, issuers of individual health insurance coverage, and providers of air ambulance services to submit detailed data regarding air ambulance services specified in the reporting requirements of the “No Surprises Act.”   The proposed rule also allows HHS to collect data related to market trends and costs in an effort to address air ambulance expenses.

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