Accountable Care Organizations:
Scrambling to Get Ready Now
by Rich Bouma
There's a scramble going on in cities all across the country as physicians, hospitals and other providers organize themselves into "accountable care organizations" in order to capture future financial rewards.
What is an ACO? An accountable care organization (ACO) is essentially a provider network, made up of independent practice groups and hospitals. But while those practice groups and hospitals are legally separate, they are also "clinically integrated," that is, sharing patient care data, establishing common treatment protocols and committed to work toward common quality benchmarks. Internally, an ACO distributes money to individual providers in its network at least in part based on their achievement of quality targets. Read full article
RAC Audits on the Upswing
by Deborah Williamson
If the experience of Warner Norcross & Judd attorneys is any indication, audits of providers and suppliers of all types by Medicare, Medicaid and other third party payors are on the upswing.
By now, you have heard of Recovery Audit Contractors (RACs), the independent third-party contractors paid on a contingency basis to identify and correct improper Medicare payments. While these "bounty hunters" have focused their efforts primarily on hospital providers, others are at risk, too. Namely, non-institutional providers, including physicians, home health services and Durable Medical Equipment (DME) suppliers also may be targeted for a RAC audit. Read full article
A Warning for Medical Practices:
Monitor Your Opioid Prescriptions
by Rich Bouma
We've been asked to pass on a warning to medical practices from a United States Attorneys office in Michigan. Though it's a sensitive topic, we think it’s a serious message: There is a drug enforcement crackdown coming in Michigan, aimed at medical practices that fail to exercise due care in prescribing opioids. Medical practices need to make sure they do not get inadvertently snared. Read full article