Year: 2019
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Opioid Cumulative Daily Morphine Milligram Equivalents Limit – MME Decrease
Effective December 2, 2019, the Alabama Medicaid Agency will implement hard edits on cumulative daily MME claims exceeding 200 MME/day. A phase-in period for claims exceeding 150 MME/day, but less than 200 MME/day, will also be implemented. Examples of MME calculations/day include: • 10 tablets per day of hydrocodone/acetaminophen 5/325 = 50 MME/day • 6…
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ALAPAC-Supported Van Smith Wins Special Election
On Tuesday, Autauga County Commissioner Van Smith won the special election to fill the vacancy in Alabama House District 42 with 88% of the vote. ALAPAC has supported Van since the Primary, with a key reason being the advocacy of area physicians who have known and worked with Mr. Smith for years and who spoke…
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CMS Releases Physician Fee Schedule Final Rule
The Centers for Medicare and Medicaid Services (CMS) released its final rule for the CY 2020 Physician Fee Schedule. The Medical Association and the AMA will continue to review the rule and analyze these policies in the coming weeks. Attached is a summary of some of the policies CMS finalized in the rule. Some of…
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Changes Coming to AKS, Stark and CMP Laws
On October 9, 2019, the Office of Inspector General (“OIG”) and the Centers for Medicare and Medicaid Services (“CMS”) published proposed rules to revise the Stark Law, Anti-Kickback Statute and Civil Monetary Penalty Statute. These statutes create criminal and civil penalties for certain financial arrangements involving providers. According to OIG and CMS, the goal of…
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Closing Your Medical Practice – Calling it Quits!
There is a lot of media attention to “Baby Boomers” retiring with more than 10,000 leaving the workplace every day. Anyone closing a business has a list of items to address before selling the business or closing the doors, but there is a unique set of considerations when a physician practice owner elects to retire…
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Doctors Unite in Support of Physician Office Exemption
We called and you answered! Thank you to all the physicians who answered the urgent call-to-action and quickly signed on to the Medical Association letter (more than 600 doctors to date!) challenging the Alabama Hospital Association (ALAHA) and its member facilities’ contentions about the appropriateness of the physician office exemption (POE) from CON review. As you know,…
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Letter to Congress: Don’t Give Health Plans Too Much Power
The American Medical Association wrote two letters to Congress to shed light on how physicians feel about the current debate in Washington over surprise billing. We, along with 109 other state medical societies and national specialty societies, co-signed this letter to support the AMA’s efforts. The letters advocate for independent dispute resolution (IDR), a process…
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Fraud and Abuse Facelift: Proposed Changes to Stark, AKS, and Beneficiary Inducements CMP
As part of its “Regulatory Sprint to Coordinated Care,” the Centers for Medicare and Medicaid Services (“CMS”) and the Health and Human Services Office of Inspector General (“OIG”) released proposals to modernize the Medicare Physician Self-Referral Law (“Stark Law”), Anti-Kickback Statute (“AKS”), and Beneficiary Inducements Civil Money Penalty (“CMP”) (collectively, the “Proposed Rules”). The Proposed…
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Medical Association Opposes Scope of Practice Expansion Executive Order
President Trump issued an executive order on October 3, 2019 as an alternative to “Medicare for All”. Initially, the order was titled “Protecting Medicare From Socialist Destruction” but was changed to “Protecting and Improving Medicare for Our Nation’s Seniors.” The executive order does include some items that the Medical Association of the State of Alabama…
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CMS Is Expanding Its Enforcement Ability
Pursuant to a new rule, entitled Program Integrity Enhancements to the Provider Enrollment Process, the Centers for Medicare & Medicaid Services (“CMS”) is expanding its ability to combat fraud and abuse within the healthcare industry. Under the new rule, CMS will be able to identify individuals and entities that pose a fraud and abuse risk…