CMS Comparative Billing Reports Signal Areas Of Compliance Scrutiny

Aug 28, 2018 | DMEPOS, Physician Fee Schedule, Physicians, Substance Abuse

Every year, CMS releases Comparative Billing Reports (CBRs) to about 10-12 provider groups.  CBRs are issued in the form of letters sent to individual providers which analyze and compare individual provider billing patterns with other similar providers in their state and nationally. Typically, CBRs are inspired by past or pending OIG reports or other concerns raised about basic billing patterns, so they effectively put providers on alert that their specialty is being given extra attention, and makes them aware if they are outliers among billers in their specialty. In this brief, we have...

Coverage Mandates, A Tailwind for Substance Use Disorder Providers

Jul 25, 2018 | Behavioral, Substance Abuse

The Affordable Care Act designated mental health and substance use services as essential health benefits in Marketplace plans and also extended parity requirements to the individual and small-group markets. This brief highlights a recent Health Affairs study that analyzed the extent to which the law improved coverage for these services. Read more here.

MACPAC June Report Covers Drug Rebates, SUD Treatment, And Managed Long-Term Care

Jun 21, 2018 | Drugs, Medicaid, Medicaid Managed Care, Substance Abuse

In its June 2018 Report to Congress, the Medicaid and CHIP Payment and Access Commission made recommendations to change a Medicaid rebate loophole preventing states from paying the lowest price for certain drugs, and to clarify privacy requirements for people with substance use disorder that may inhibit care coordination. The report also addressed the growth of managed long-term services and supports and state coverage of substance use disorder services. Click to read more.

Department of Justice Establishes Opioid Task Force

Mar 8, 2018 | Drugs, Substance Abuse

Attorney General Jeff Sessions recently announced the Department of Justice’s new Prescription Interdiction and Litigation (PIL) Task Force. The task force will coordinate all available criminal and civil law enforcement tools to fight the opioid crisis, with a focus on manufacturers and distributers. The Justice Department will file a statement of interest in a multidistrict lawsuit against several opioid manufacturers and distributers for the substantial costs the federal government has suffered from opioid addiction. The creation of this new task force reflects the national commitment to...