Debra McCurdy

Debra McCurdy

Reed Smith

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CMS Proposes Medicare Physician Fee Schedule Update for 2017

The Centers for Medicare & Medicaid Services (CMS) has published its proposed rule to update the Medicare physician fee schedule (MPFS) for calendar year (CY) 2017. The proposed rule contains numerous Medicare payment and...more

7/19/2016 - CMS Comment Period Diagnostic Imaging Services Enrollment Health Care Providers Medicare Medicare Access and CHIP Reauthorization (MACRA) Medicare Advantage MPFS Open Payments PAMA Proposed Regulation Stark Law Suppliers Telehealth

Obama Administration, Congress Take Steps to Fight Opioid Epidemic

HHS has announced a series of actions to address the nation’s opioid epidemic, as Congress has cleared the Comprehensive Addiction and Recovery Act for the President’s signature. As part of the HHS activities, the Substance...more

7/19/2016 - Bipartisan Agreement Final Rules HHS Hospitals Medicare Advantage Medicare Part D OIG Opioid Pain Management Pending Legislation Pharmaceutical Industry Prescription Drugs Public Health SAMHSA Substance Abuse Value-Based Purchasing

CMS Guidance Addresses Impact of Value-Based Purchasing on Medicaid Drug Rebates

CMS has received questions from manufacturers regarding whether price concessions and services offered to payers within Value-Based Purchasing (VBP) arrangements in the pharmaceutical marketplace could impact their drug’s...more

7/19/2016 - CMS Drug Pricing Managed Care Contracts Manufacturers Medicaid New Guidance Prescription Drugs Rebates Value-Based Purchasing

CMS Proposes Update to Medicare OPPS, ASC Rates and Policies for 2017

CMS has published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for CY 2017. CMS proposes a 1.55%...more

7/19/2016 - Ambulatory Surgery Centers Bipartisan Budget Act CMS Comment Period Electronic Health Record Incentives Health Care Providers Hospitals Medical Devices Medicare Off-Campus Departments OPPS Outpatient Quality Reporting Proposed Regulation

House of Representatives Approves Mental Health System Reform Bill

The House of Representative has overwhelmingly approved a bipartisan bill (H.R. 2646, the Helping Families in Mental Health Crisis Act) to reform the nation’s mental health care system. Key provisions of the legislation...more

7/19/2016 - Bipartisan Agreement Healthcare Reform HELP HIPAA Medicaid Mental Health Mental Health Initiatives Mental Health Parity Rule Pending Legislation PHI Secretary of HHS Substance Abuse

Committees Approve Rural Hospital Relief, ESRD Benefits, Medical Countermeasures Bills

On July 13, 2016, the Ways and Means Committee approved HR 5659, which would enable Medicare beneficiaries with end stage renal disease (ESRD) to enroll in Medicare Advantage plans. Earlier this month, the Committee approved...more

7/19/2016 - CMS Congressional Committees Critical Access Hospitals ESRD Hospitals Medicare Medicare Advantage Proposed Legislation Public Health Rural Health Care Providers Ways and Means Committee

HHS Proposes Rules to Streamline the Medicare Appeals Process to Address Backlog

The Department of Health and Human Services (HHS) has issued a proposed rule intended to address the significant backlog resulting from “an unprecedented and sustained increase” in Medicare appeals. According to HHS, its...more

7/19/2016 - ALJ CMS Comment Period HHS Medicare Medicare Appeals Council OMHA Precedential Opinion Proposed Regulation

CMS Finalizes Plan to Expand Medicare/Private Claims Data Available for Care Improvement

CMS has published a final rule to allow organizations approved as “qualified entities” to confidentially share or sell analyses of Medicare and private-sector claims data to providers, employers, and other groups who can use...more

7/18/2016 - Affordable Care Act CMS Final Rules Health Care Providers HIPAA Medicare Medicare Access and CHIP Reauthorization (MACRA) PHI Reporting Requirements Suppliers

OIG, CMS Focus New Scrutiny on Home Health Industry: Additional Investigative and Enforcement Activity Likely to Follow

On June 22, 2016, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a comprehensive report detailing its nationwide analysis of common characteristics in home health fraud cases. In tandem...more

7/7/2016 - Analytics CMS Fraud Abuse and Waste Fraud Alerts Healthcare Fraud Home Health Agencies Home Health Care Medicare OIG Physicians

CMS Proposes Changes to Medicare DMEPOS Competitive Bidding & Fee Schedule Update Policies

CMS has proposed a series of complex and detailed revisions to Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) policies for 2017, including changes to the competitive bidding program (CBP)...more

7/6/2016 - CMS Comment Period Competitive Bidding DMEPOS Medicare Medicare Access and CHIP Reauthorization (MACRA) Proposed Regulation Suppliers

CMS Issues Proposed CY 2017 Medicare ESRD PPS Update

The Centers for Medicare & Medicaid Services (CMS) has published its proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2017. CMS anticipates that the...more

7/6/2016 - CMS Comment Period ESRD Health Care Providers Hospitals Medicare Proposed Regulation

Bigger Apparently is Better in DOJ’s Eyes – DOJ Piles On as False Claims Act CMPs Set to Almost Double on August 1, 2016

On June 30, 2016, the Department of Justice published an interim final rule with request for comments that applies an inflation adjustment to civil monetary penalty (CMP) amounts assessed by the Department, as mandated by the...more

6/30/2016 - Bipartisan Budget Civil Monetary Penalty Comment Period Corporate Counsel DOJ False Claims Act (FCA) Health Care Providers Interim Rule Manufacturers Suppliers

CMS Proposes CY 2017 Update to Medicare Home Health PPS Rates

CMS has released its proposed rule to update the Medicare home health prospective payment system (HH PPS) for 2017. CMS estimates that the policies in the proposed rule would reduce overall Medicare payments to home health...more

6/30/2016 - CMS Comment Period Home Health Agencies Home Health Care IMPACT Act Medicare Outlier Payments Proposed Regulation Value-Based Purchasing

CMS to Slash Medicare DMEPOS Rates on July 1, 2016

CMS has released the July 1, 2016 update to Medicare durable medical equipment (DME) prosthetic orthotics and supplies (DMEPOS) fee schedule amounts in non-competitive bidding areas, reflecting full implementation of...more

6/29/2016 - Affordable Care Act CMS Competitive Bidding DMEPOS Medicare Pending Legislation

CMS Steps Up Efforts to Recover Overpayments from Providers/Suppliers Sharing TINs

CMS has just announced that it has enhanced its financial accounting system to allow it to recover Medicare payments made to a provider or supplier that shares the same Tax Identification Number (TIN) with a provider or...more

6/24/2016 - CMS Health Care Providers Medicare Medicare Administrative Contractors (MAC) Overpayment

CMS Finalizes Changes to Medicare Clinical Lab Test Payment Policy, Pushes Back Effective Date to 2018

On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) is publishing a major final rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts, as required by...more

6/23/2016 - CLFS Clinical Laboratories CMS Diagnostic Tests Final Rules Health Care Providers Medicare PAMA Reporting Requirements

Senate Passes Legislation to Delay Pending Medicare DMEPOS Fee Schedule Cuts Based on Competitive Bidding Prices

As previously reported, the Affordable Care Act mandates that CMS use pricing information from the durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program (CBP) to adjust...more

6/23/2016 - Affordable Care Act CMS Competitive Bidding DMEPOS Medicare Pending Legislation

CMS Announces Pre-Claim Review Demonstration for Medicare Home Health Services

CMS has announced a new three-year Medicare “pre-claim review” demonstration for home health services in five states — Illinois, Florida, Texas, Michigan, and Massachusetts — with “high incidences of fraud and improper...more

6/23/2016 - CMS Demonstration Project Health Care Providers Home Health Agencies Home Health Care Medicare Medicare Administrative Contractors (MAC)

MedPAC Issues Recommendations on Medicare Drug, Post-Acute Care, and Other Payment Policies

MedPAC has released its June 2016 Report to the Congress on Medicare and the Health Care Delivery System. The report includes recommendations for a number of Medicare policy reforms and analyses of various health care market...more

6/23/2016 - CMS Congressional Reports Medicare Medicare Access and CHIP Reauthorization (MACRA) Medicare Part B Medicare Part D MedPAC Prescription Drugs Telehealth

CMS Proposes Changes to Hospital CoPs to Promote Quality, Strengthen Discrimination Protections

CMS has published a proposed rule on June 16, 2016 that would update the standards hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid. Specifically, CMS proposes to revise the...more

6/22/2016 - Anti-Discrimination Policies CMS Comment Period Critical Access Hospitals Hospitals Medical Records Proposed Regulation

OIG Identifies Continued Vulnerabilities in Medicare Provider-Based Facility Payment Policy

A new OIG report examines CMS’s oversight of Medicare billing by provider-based facilities – that is, facilities that operate under the ownership, administrative, and financial control of a hospital and meet other...more

6/22/2016 - CMS Health Care Providers Hospitals Medicare OIG OPPS Overpayment

CMS Proposes Changes to Payment Error Rate Measurement (PERM) & Medicaid Eligibility Quality Control (MEQC) Programs

CMS has issued a proposed rule to make changes to the PERM and MEQC programs to align with changes to state adjudication of Medicaid and Children’s Health Insurance Program (CHIP) eligibility under the Affordable Care Act....more

6/22/2016 - Affordable Care Act CHIP CMS Comment Period Eligibility Medicaid PERM Proposed Regulation

GAO Highlights Significant Backlog in Medicare Appeals, Routine ALJ Failure to Meet Statutory Deadlines

The Medicare appeals process has not been able to keep up with an explosion in the number of volume, particularly at the administrative law judge (ALJ) level (Level 3), resulting in significant backlogs and widespread failure...more

6/21/2016 - ALJ Fee-for-Service GAO HHS Medicare Medicare Administrative Contractors (MAC) Medicare Appeals Council Medicare Claims Appeals Process Recovery Audit

CMS Finalizes Changes to Medicare Shared Savings Program/ACO Benchmark Rebasing Rules

CMS has published a final rule that revises the methodology CMS uses to measure the performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. According to CMS, the changes are intended to...more

6/21/2016 - ACOs Benchmarking CMS Fee-for-Service Final Rules Medicare Medicare Shared Savings Program

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