Debra McCurdy

Debra McCurdy

Reed Smith

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CMS Posts October 2015 Medicare Part B Drug Payment Update

CMS has posted the October 2015 update to the Medicare Part B drug average sales price (ASP) files, containing the payment rates that will apply for the fourth quarter of 2015. On average, prices for the top Part B drugs...more

9/2/2015 - CMS Drug Pricing Medicare Medicare Part B Prescription Drugs

OMB Reviewing CMS Proposed Rule on PAMA Clinical Lab Test Payment Policy

CMS is finally taking steps to implement the Medicare clinical laboratory payment reforms mandated by the Protecting Access to Medicare Act of 2014 (PAMA). Under PAMA, CMS must base Medicare payment rates for clinical...more

9/2/2015 - Clinical Laboratories CMS Data Collection Medicare OMB Payment Systems Protecting Access to Medicare Act

OIG Reviews Overlap Between Physician-Owned Hospitals and Physician-Owned Distributors (PODs) of Spinal Devices

The Office of Inspector General (OIG) of the Department of Health and Human Services has issued a report on “Overlap Between Physician-Owned Hospitals and Physician-Owned Distributors.” The OIG reviewed 12 hospitals that...more

8/27/2015 - CMS Healthcare Healthcare Professionals Medicaid Medical Devices Medicare OIG Physician-Owned Distributors Physician-Owned Hospitals Sunshine Act

CMS Publishes Corrections to Comprehensive Care for Joint Replacement Model Proposed Rule

On August 25, 2015, the Centers for Medicare & Medicaid Services (CMS) published technical and typographical corrections to its July 14, 2015 proposed rule to establish a Comprehensive Care for Joint Replacement Model. As...more

8/27/2015 - Bundled Payments CMS Comment Period Healthcare Healthcare Professionals Hospitals Medicaid Medicare Proposed Regulation

CMS Updates Inpatient Hospital “Two Midnight” Review Education/Enforcement Strategy

CMS recently provided an update on its education and enforcement strategies related to its “Two Midnight” policy, which addresses when surgical procedures, diagnostic tests and other treatments are generally considered...more

8/27/2015 - CMS Healthcare Healthcare Professionals Hospitals Medicare Access and CHIP Reauthorization (MACRA) Medicare Administrative Contractors (MAC) Medicare Part A QIOs Recovery Audit Contractor Two-Midnight Rule

CMS Seeks Feedback on Home Health Face-to-Face Encounter Clinical Templates

CMS is inviting comments on voluntary home health electronic and paper “progress note” templates intended to assist physicians with documenting a face-to-face examination for purposes of the Medicare home health benefit....more

8/27/2015 - CMS Comment Period Healthcare Professionals Home Health Care Medicare Physicians

CMS Announces Timeline for the DMEPOS Competitive Bidding Round 1 2017 Competition

On August 11, 2015, CMS announced the detailed timeline for “Round 1 2017” of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. As previously reported, this...more

8/13/2015 - CMS Competitive Bidding DMEPOS Medicare

OIG Recommends Improvements to SNF Billing for Changes in Therapy

In FYs 2011 and 2012, CMS adopted new patient assessments for skilled nursing facilities (SNFs) that were intended to capture when beneficiaries start therapy, end therapy, and decrease or increase therapy. The HHS Office of...more

8/11/2015 - Beneficiaries CMS Healthcare Healthcare Professionals Incentives Medicare OIG Regulatory Oversight Skilled Nursing Facility

President Signs Hospital Outpatient Observation Status “Notice” Act

On August 6, 2015, President Obama signed into law H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility Act. The new law requires hospitals to provide written and oral notification to Medicare...more

8/10/2015 - Beneficiaries Cost-Sharing Healthcare Healthcare Professionals Hospitals Medicare New Legislation Notice Requirements Skilled Nursing Facility Written Notice

Terminated Medicaid Providers Continue to Participate in Other State Medicaid Programs

According to the HHS Office of Inspector General (OIG), 12% of providers terminated for cause by a state Medicaid program in 2011 continued participating in other states’ Medicaid programs as of January 2014, despite an...more

8/7/2015 - Affordable Care Act CMS Healthcare Healthcare Professionals Healthcare Providers Medicaid Medicare OIG State Medicaid Programs Termination

GAO Examines Medicare Provider Eligibility Verification Safeguards

The Government Accountability Office (GAO) has issued a report examining the extent to which CMS’s enrollment screening procedures are designed and implemented to prevent enrollment of ineligible or potentially fraudulent...more

8/7/2015 - CMS Enrollment GAO Healthcare Healthcare Professionals Medicaid Medicare Screening Procedures

First Meeting of Advisory Panel on Clinical Diagnostic Laboratory Tests on August 26, 2015

CMS has announced that the first meeting of the Advisory Panel on Clinical Diagnostic Laboratory Tests will be held on August 26, 2015. The Panel will recommend crosswalks for new laboratory codes, recommend an appropriate...more

8/7/2015 - Clinical Laboratories CMS Controlled Substances Healthcare Healthcare Professionals Medicaid Medicare Prescription Drugs

CMS Issues Final FY 2016 Medicare IPPS/LTCH Rule

On July 31, 2015, the Centers for Medicare & Medicaid Services (CMS) released a major final rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and the long-term care hospital prospective...more

8/7/2015 - Affordable Care Act American Taxpayer Relief Act CMS Electronic Medical Records Final Rules Healthcare Healthcare Professionals Hospitals Inpatient Quality Reporting IPPS Long Term Care Facilities Market Basket Medicaid Medicare Payment Systems Value-Based Purchasing

CMS Finalizes Medicare IRF PPS Rates/Policies for FY 2016

On August 6, 2015, CMS published its final rule to update Medicare PPS rates for inpatient rehabilitation facilities for FY 2016, which begins October 1, 2015. CMS estimates that rates will increase by 1.8% overall ($135...more

8/7/2015 - Affordable Care Act CMS Final Rules IMPACT Act Inpatient Quality Reporting Inpatient Rehab Facilities Market Basket Medicaid Medicare Payment Systems Wage Index

CMS Publishes Final FY 2016 Update to SNF PPS Rates, Policies

On August 4, 2015, CMS published its final rule updating Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2016. CMS projects that the final rule will increase overall payments to SNFs by $430 million, or...more

8/7/2015 - Affordable Care Act CMS Final Rules Healthcare Healthcare Professionals Hospital Readmission IMPACT Act Market Basket Medicaid Medicare Nursing Homes Protecting Access to Medicare Act Provider Payments Reporting Requirements Skilled Nursing Facility

Obama Administration Finalizes Regulations on ACA Coverage of Preventive Services, Including Contraceptive Services

The Obama Administration published final regulations on July 14, 2015 that implement Affordable Care Act requirements regarding coverage without cost sharing of certain preventive services, including contraceptive services....more

8/6/2015 - Affordable Care Act Closely Held Businesses Contraceptive Coverage Mandate Cost-Sharing Department of Health DOL Employer Group Health Plans Health Insurance Obama Administration Preventive Health Care Religious Exemption U.S. Treasury

CMS Publishes Final FY 2016 Medicare Inpatient Psychiatric Facilities PPS Rule

Today CMS published its final rule updating payment policies and rates for the Medicare Inpatient Psychiatric Facilities (IPF) Prospective Payment System (PPS) for FY 2016. The final rule provides a 1.5% increase to IPF PPS...more

8/6/2015 - Affordable Care Act CBSA CMS Final Rules Inpatient Prospective Payment System Inpatient Quality Reporting Medicare Payment Systems Psychiatric Hospitals Wage Index

Energy & Commerce Committee Approves Bipartisan Health Bills

On July 29, 2015, the House Energy & Commerce Committee approved the following bipartisan bills that aim to improve health care for newborns, infants, and children...more

8/6/2015 - Bipartisan Agreement Congressional Committees Controlled Substances Healthcare Healthcare Professionals Pending Legislation Stem cells Substance Abuse

Senate Approves Hospital Outpatient Observation Status “Notice” Act

On July 27, 2015, the Senate approved H.R. 876, the Notice of Observation Treatment and Implication for Care Eligibility Act, clearing the measure for the President. H.R. 876 would require hospitals to provide written and...more

8/6/2015 - Cost-Sharing Eligibility Healthcare Healthcare Professionals Hospitals Medicare Pending Legislation Skilled Nursing Facility Written Notice

MedPAC Issues 2015 Medicare Data Book

The Medicare Payment Advisory Commission (MedPAC) has released its 2015 Data Book on Health Care Spending and the Medicare Program. The publication provides information on national health care and Medicare spending, Medicare...more

8/5/2015 - Healthcare Healthcare Providers Medicare Medicare Advantage Medicare Part D MedPAC

CMS Finalizes Medicare Hospice Wage Index/Rates for FY 2016

On August 6, 2015, CMS is publishing its final rule to update Medicare hospice payment rates and the wage index for fiscal year (FY) 2016. CMS estimates that the final rule will increase overall payments to hospices by about...more

8/5/2015 - CMS Final Rules Hospice IMPACT Act Medicare Nurses Skilled Nursing Facility Wage Index

CMS Again Extends Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS has announced another 6-month extension of its current temporary enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs), subunits, and branch locations in designated metropolitan areas....more

8/5/2015 - Ambulance Providers CHIP CMS Enrollment Healthcare Healthcare Professionals Home Health Agencies Medicaid Medicare Moratorium Time Extensions

President Obama Signs Steve Gleason Act and Independence at Home Act

On July 30, 2015, President Obama signed into law: ..S. 984, “Steve Gleason Act of 2015” – a bill to cover as durable medical equipment eye tracking and gaze interaction accessories for speech generating devices...more

8/5/2015 - Barack Obama Durable Medical Equipment Healthcare Healthcare Professionals Home Health Care Medical Devices New Legislation

CMS Call: Countdown to ICD-10 (Aug. 27)

On August 27, 2015, CMS is hosting a call to help health care providers prepare for ICD-10 implementation on October 1, 2015. CMS staff will be joined by representatives of the American Health Information Management...more

7/28/2015 - American Hospital Association CMS Healthcare Healthcare Professionals Healthcare Providers ICD Codes ICD-10 Medicaid Medicare

CMS Call on Proposed Reform of LTC Facility Requirements (Aug.11)

On August 11, 2015, CMS is hosting a provider call to discuss its proposed rule to reform the Medicare and Medicaid participation requirements for long-term care (LTC) facilities. A question and answer session will follow the...more

7/28/2015 - CMS Healthcare Healthcare Professionals Healthcare Providers Long Term Care Facilities Long-Term Care Medicaid Medicare Proposed Regulation

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