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Allen Miller, Chief Executive Officer, COPE Health Solutions

Key Trends in 2018 for Health Care Organizations Moving to Value-based Payment and Population Health Management



By Allen Miller
Chief Executive Officer
COPE Health Solutions


Healthcare is in a tumultuous time and what's for certain is that nothing is for certain. The passing of the recent Tax Cuts and Jobs Act of 2017 (TCJA) has broad but still not completely understood implications for the business community and economy, including non-profit health hospitals and health care systems, generally adding more complexity and uncertainty. It is also unclear what impact the elimination of Accountable Care Act (ACA) individual mandate penalties will have on uninsured rates. This uncertainty has not stopped, and perhaps has fueled, interest by employers and investors in creating alternative health care financing and delivery models, as evidenced by the recent announcement between JPMorgan Chase, Berkshire Hathaway, and Amazon.  Read article
Data Entry Clerk Entering Claim Information

Coding Errors May Render Receivables Uncollectible


By Adam G. Wentland
Attorney, Theodora Oringher PC

"Double check your coding!," is the harsh lesson to healthcare providers from the recent California Court of Appeal's opinion in YDM Management v. Sharp Community Medical Group. The Court ruled that the defendant, an independent practice association, was not required to pay a single cent more than it had due to the provider's CPT coding mistakes - costing hundreds of thousands of dollars.  Read article
Medical Staff Meeting to Discuss Organization Effectiveness

Challenges to Overcome to Operate an Effective Healthcare Organization


By Sergey Gorbatov, PMP


The healthcare industry in the United States has transformed and evolved throughout the decades, continuously adapting to changes in regulatory policy, technology, patient preferences and economic climate. Consequently, these factors not only affected the delivery of healthcare as whole, but heavily impacted organizational and operational structures of healthcare companies. Further changes in business operations produced new, or underscored existing challenges with managing organizational behavior and human resources that leaders had to understand and effectively manage to continue operating successful businesses. Borkowski (2011) suggests a set of challenges that leadership would encounter and would need to overcome to operate an effective healthcare organization: (1) diversity of the workforce as it relates to ethnicity, culture, geographical location and age; (2) effectiveness of communication; and (3) ensuring an efficient and productive work environment through appropriate evaluation and management of staff's attitudes. This article will focus on each challenge in greater detail. Read article
Medical Staff Receiving Training on TPE Program

CMS's Targeted Probe and Educate ("TPE") Program - Get Counsel Involved Early!


By Richard S. Cooper, Esq.
Member, McDonald Hopkins LLC

On October 1, 2017, CMS expanded its pilot Targeted Probe and Educate (“TPE”) program to include all MACs. CMS’s stated purpose for the expansion is “to reduce appeals, decrease provider burden, and improve the medical review/education process.” CMS has described the program as “designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.” This is a 3-round program conducted by the provider’s local MAC. It offers one-on-one education and is intended to reduce payment error rates for the provider. Hopefully, the provider is also able to use the program to avoid an overpayment demand or payment suspension.  Read article
Smog of Downtown Los Angeles

Climate Change and Human Health


By Paul S. Auerbach MD, MS, FACEP, FAWM, FAAEM
Redlich Family Professor in the Department of Emergency Medicine, Stanford University School of Medicine

From the vantage point of emergency medicine, climate change is a clear and present danger to human health. One needn't be a climate scientist or pulmonary specialist to appreciate the impact of thick smoke on the tenuous lungs of a patient with chronic asthma. When mosquitoes move north into habitats made newly favorable by global warming, they will breed at higher rates and more effectively incubate vectors of tropical diseases previously unknown to these human populations. Superstorms are becoming the norm as warmer oceans evaporate more moisture into cloud formations and render cataclysmic events. Coral reefs and oyster beds have been decimated. Droughts, heat waves, floods, and wildfires dominate the news. So, where does the medical profession stand on all of this?  Read article
Child Receiving Dental Care

Expanded Medi-Cal Benefits Improve Lives of Many California Dental Patients


By John Luther, DDS
Chief Dental Officer, Western Dental & Orthodontics

Dental care benefits under Medi-Cal – and the over 13 million Californians who depend on them – took a big hit in 2009. State budget constraints caused by the onslaught of the Great Recession resulted in deep cuts to state services, including basic dental care under the Medi-Cal program.
Eight years later, as the economy slowly recovered, California lawmakers passed a bill that fully reinstated those reduced benefits, providing improved dental care services not previously included as covered benefits under Medi-Cal. The changes took effect January 1, 2018.  Read article
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