The end of 2021 brings positive indications of the continued acceptance of telehealth as an important clinical care approach post public health emergency (“PHE”). The Centers for Medicare and Medicaid Services (“CMS”), like...more
2/22/2022
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Medicare Advantage ,
Outpatient Prospective Payment System (OPPS) ,
Payor Contracts ,
Physician Fee Schedule ,
Section 340B ,
Surprise Medical Bills ,
Telehealth
The Centers For Medicare & Medicaid Services Issues New Inpatient Prospective Payment System Final Rule -
On September 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2021 Medicare...more
12/31/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Cramdown ,
Drug Pricing ,
Health Care Providers ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medicare ,
Physician Fee Schedule ,
Physician Medicare Reimbursements ,
Section 340B ,
Telehealth ,
Value-Based Care
Introduction -
CMS has taken extensive measures to assist providers and promote access to care in light of the Public Health Emergency (PHE) related to the COVID-19 pandemic. The efforts taken have and continue to benefit...more
8/4/2020
/ Audits ,
CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
COBRA ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Health Insurance ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Skilled Nursing Facility ,
Telehealth ,
Telemedicine
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
...more
11/1/2019
/ Administrative Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Contract Disputes ,
Enrollment ,
Health Care Providers ,
Injunctive Relief ,
Managed Care Contracts ,
Medical Reimbursement ,
Medicare ,
Payor Contracts ,
Revocation ,
Site-Neutral Exception ,
Universal Health Services Inc v United States ex rel Escobar
On June 3, 2019, the Supreme Court issued an eagerly anticipated opinion in Azar v. Allina Health Services, a decision with far-reaching implications both for the calculation of disproportionate share payments and provider...more
7/10/2019
/ Administrative Procedure Act ,
Azar v Allina Health Services ,
Department of Health and Human Services (HHS) ,
Hospitals ,
Low-Income Issues ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part C ,
Notice and Comment ,
Pay Reductions ,
Provider Payments ,
Reaffirmation ,
Retroactive Application ,
SCOTUS ,
Substantive Rule ,
Vacated
On Wednesday July 25, 2018, the Centers for Medicare and Medicaid Services (CMS) released an advance copy of the CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule. ...more
Hospitals with off-campus provider-based departments (“PBDs”) under construction (or “mid-build”) at the time of the Bipartisan Budget Act of 2015 – which limited Medicare payment to off-campus provider-based departments that...more
A new section of the 21st Century Cures Act provides much-needed relief for hospitals with an off-campus provider-based department (off-campus PBD) that was mid-build or under development as of November 2, 2015 (the Mid-Build...more
2/8/2017
/ 21st Century Cures Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Certification Requirements ,
Compliance Dates ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicare ,
Medicare Administrative Contractors (MAC) ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Professional Development
For relocations that occurred between 11.2.15 and 12.31.16, providers must submit relocation requests by 1.31.2017.
The CY 2017 OPPS Final Rule brought significant changes to the way Medicare reimburses hospitals for...more
CMS recently finalized sweeping changes to the way Medicare pays hospitals for services furnished in “new” off-campus provider-based departments (referred to as “off-campus PBDs”).
CMS revealed the changes on November 1...more
As part of the CY 2017 proposed Hospital Outpatient Prospective Payment System rules (OPPS) the Centers for Medicare and Medicaid Services (CMS) released the long awaited proposed payment changes for items and services...more
On February 12, 2016, CMS published the Reporting and Returning of Overpayments Final Rule (Final Rule). The Final Rule takes effect on March 14, 2016. Overall, CMS appears to have listened to stakeholders and acknowledged...more
Without fanfare or any significant discussion, the Bipartisan Budget Act (Act) contains the first legislative action related to provider-based status—and it is a sweeping action with negative financial consequences to many...more
11/2/2015
/ Bipartisan Agreement ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Health Care Providers ,
Healthcare ,
Medicare ,
MedPAC ,
Obama Administration ,
OIG ,
OPPS ,
Pending Legislation ,
Pharmaceutical Industry ,
Physician Fee Schedule ,
Prescription Drugs ,
Section 340B
In This Issue:
- Top News
..Congress Passes Omnibus Spending Package
..HRSA Cancels Plan for 340B ‘Mega Reg’; Congress Weighs Options
..Supreme Court to Hear Challenge to ACA...more
12/22/2014
/ Affordable Care Act ,
Appropriations Bill ,
Centers for Medicare & Medicaid Services (CMS) ,
Halbig v Burwell ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
HRSA ,
King v Burwell ,
Legislative Agendas ,
Medicare ,
Medicare Shared Savings Program ,
Physicians ,
SCOTUS ,
Section 340B ,
Subsidies
In This Issue:
- Top News
..The Congressional Agenda is Light as the Focus Shifts to the Midyear Elections
..Physician Supervision Requirement for Small and Rural Hospitals
..CMS Offers Hospitals...more
9/29/2014
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
HRSA ,
Medicaid ,
Medicare ,
Medicare Part B ,
MedPAC
Enrollment in Health Plans under ACA Exceeds Projected Number of 7 Million -
The White House announced on April 1 that 7.1 million Americans had enrolled in health plans under the Affordable Care Act ("ACA"). ...more
In This Issue:
- Top News
..Congress Approves Budget Deal with Short-Term ‘Doc Fix'
..CMS “Two-Midnight” Rule delayed until March 31, 2014
..Individuals with Canceled Insurance Policies May Apply for...more
1/24/2014
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
EHR ,
Exempt Organizations ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Fraud ,
Healthcare Reform ,
Hospitals ,
Medicare ,
Misbranding ,
OCR ,
OIG ,
Prescription Drugs ,
Tax Exemptions
In This Issue:
- Top News
..CMS Releases Payment Rules for the Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System, Renal Dialysis and Home Health
..President Signs the Drug Quality...more
In This Issue:
- Top News
..Judge Orders $237.4 Million Penalty Against Tuomey for Stark Law and False Claims Act Violations
..Glitches and Demand Lead to Marketplace Frustration
..HHS Delays Small...more
10/16/2013
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Food and Drug Administration (FDA) ,
Health Insurance Exchanges ,
Healthcare ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Open Enrollment ,
Pharmacies ,
Physician Medicare Reimbursements ,
Stark Law
In This Issue:
- What Providers Should Know
- Requirements for Inpatient Admissions and Payment Under Medicare Part A
- New Rules Permitting Re-billing Under Medicare Part B for Denied Admissions
- New HAC...more
In This Issue:
- Top News
..Obama Administration Delays Employer Mandate One Year
..House Energy and Commerce Committee Releases Draft Legislation for SGR Fix
..CMS Proposes Payment Changes for Medicare...more
7/11/2013
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Competitive Bidding ,
Contraceptive Coverage Mandate ,
Contraceptives ,
Delays ,
Department of Health and Human Services (HHS) ,
Drug Distribution ,
Food and Drug Administration (FDA) ,
Healthcare ,
Healthcare Reform ,
Home Health Care ,
Medicaid ,
Medical Devices ,
Medicare ,
OIG ,
Over-the-Counter Sales ,
Pay or Play ,
Pharmaceutical Industry ,
Prescription Drugs
In This Issue:
- Top News
..CMS Finalizes MLR Rule for Plans, Maintaining Application to Part D Sponsors
..Early State Filings Show Premium Reductions under ACA
..HHS Received More Than 830 Letters of...more
6/11/2013
/ Abortion ,
Affordable Care Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Food and Drug Administration (FDA) ,
Health Insurance Exchanges ,
Healthcare ,
Medicaid Expansion ,
Medicare ,
Preexisting Conditions ,
State Health Plans ,
Wellness Programs
In This Issue:
- Top News
..Tavenner Wins Senate Confirmation to Head CMS
..US Charges 89 in Nationwide Medicare Fraud Crackdown
- State News
..Vermont Becomes Fourth State to Allow Physician-Assisted...more
5/30/2013
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Labor (DOL) ,
Fraud ,
Healthcare ,
Medicaid ,
Medical Loss Ratio ,
Medicare ,
OIG ,
Physician-Assisted Suicide ,
Prescription Drugs ,
Supply Chain
In This Issue:
- OMB Directs Department Heads to Prepare for Sequestration
- HHS Finalizes Omnibus HIPAA Rule, Enhances Privacy Requirements
- SCOTUS Says Equitable Tolling Not a Factor in DSH Case
- Report...more
1/25/2013
/ Data Protection ,
DSH ,
Equitable Tolling ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Omnibus Rule ,
HITECH Act ,
Hospitals ,
Medicaid ,
Medicare ,
OMB ,
Pay-For-Delay ,
Pharmaceutical Industry ,
SCOTUS ,
Sequestration
In response to the government’s continued focus on improving quality of care through payment policy, several changes to new and existing regulatory requirements recently came about through the 2013 Inpatient Prospective...more