Debra McCurdy

Debra McCurdy

Reed Smith

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OIG Questions Incentives for Hospice Care in Assisted Living Facilities

Today the OIG issued a report examining the growing use of Medicare hospice care in the assisted living facility (ALF) setting. According to the OIG, Medicare payments for hospice care in ALFs grew by more than 119% from 2007...more

1/23/2015 - Assisted Living Facility Healthcare Hospice Incentives Medicare OIG

Medicare DMEPOS Competitive Bidding Window is Now Open

The bidding window is now open for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round 2 Recompete and the National Mail-Order Recompete for diabetic testing...more

1/23/2015 - Competitive Bidding DMEPOS Healthcare Medicare

MedPAC Voices Concerns about Growing Volume, Burden of Medicare Quality Measures

In December 2014, CMS released a 329-page list of quality measures under consideration for the Medicare program. In a January 13, 2015 comment letter, MedPAC observes that volume of measures under consideration “reinforces...more

1/23/2015 - CMS Health Care Providers Healthcare Medicare MedPAC Quality of Care Standards

House Approves Bills to Modify ACA Rules for Employers Related to Part-Time Workers, Veterans

On January 8, 2015, the House of Representatives approved H.R. 30, the “Save American Workers Act.” The legislation would amend the ACA’s definition of “full-time employee” for purposes of the requirement that certain...more

1/23/2015 - Affordable Care Act Employer Mandates Full-Time Employees Health Insurance Healthcare Reform Legislative Agendas Proposed Amendments TRICARE

Stage 3 EHR Incentive Program, Health IT Certification Rules at OMB

HHS has sent to the White House Office of Management and Budget (OMB) for final regulatory clearance a proposed rule on Stage 3 meaningful use criteria for the Medicare and Medicaid Electronic Health Record (EHR) Incentive...more

1/23/2015 - EHR HHS Medicaid Medicare OMB Proposed Regulation Technology

CMS Publishes Medicare QIO Criteria

CMS has published notices setting forth the criteria it will use to evaluate the effectiveness and efficiency of Quality Innovation Network (QIN) and Beneficiary and Family Centered Care (BFCC) Quality Improvement...more

1/22/2015 - CMS Medicare Quality of Care Standards

OIG Examines Appropriateness of Medicare Ophthalmology Claims

The OIG recently assessed the appropriateness of claims submitted by providers for screening for, diagnosing, evaluating, or treating cataracts, wet age related macular degeneration (wet AMD), and glaucoma in 2012....more

1/22/2015 - Medicare OIG Physician Medicare Reimbursements Physicians

CMS Announces DMEPOS/Home Health/Hospice RAC, Improvements to RAC Process

CMS has announced that it has awarded the Region 5 Recovery Audit contract to Connolly, LLC (although the General Accounting Office subsequently reported that a bid protest has been filed regarding this award). The purpose of...more

1/22/2015 - CMS Durable Medical Equipment GAO Home Health Care Hospice Medical Devices Medicare Recovery Audit Recovery Audit Contractor

Electronic Distribution of Prescribing Information for Prescription Drugs & Biologicals

The FDA published a proposed rule on December 18, 2014 that would require electronic distribution of the prescribing information intended for health care professionals, which is currently distributed in paper form on or...more

1/22/2015 - Biologics Electronic Records FDA Pharmaceutical Pharmaceutical Manufacturers Prescription Drugs

CMS Guidance on Provider Timeframes for Responding to Additional Documentation Requests

CMS has updated the Medicare Program Integrity Manual to clarify that providers and suppliers have 45 days to produce documents in response to a pre-payment review Additional Documentation Request (ADR) issued by a Medicare...more

1/22/2015 - CMS MACs Medicare ZPIC

CMS Revises Down 1st Quarter 2015 Medicare Physician Fee Schedule (MPFS) Conversion Factor

CMS has posted a January 2015 release of the National Physician Fee Schedule Relative Value File, reflecting a conversion factor (CF) of $35.7547 – down slightly from the $35.8013 included in the 2015 final MPFS rule...more

1/22/2015 - CMS Physician Fee Schedule

Administration Issues Proposed Rules on ACA Summary of Benefits and Coverage, Excepted Benefits/Wraparound Coverage

On December 30, 2014, the Internal Revenue Service (IRS), the Employee Benefits Security Administration (EBSA), and the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would revise Affordable...more

1/22/2015 - Affordable Care Act CMS EBSA Employer Group Health Plans Health Insurance Health Insurance Exchanges IRS Proposed Regulation Summary of Benefits and Coverage

IRS Issues Additional ACA Requirements for Tax-Exempt Hospitals

On December 31, 2014, the IRS published final regulations providing guidance on the community health needs assessment and financial assistance policy requirements for charitable hospitals under the ACA. ...more

1/22/2015 - Affordable Care Act Charitable Organizations CHNA Final Rules Healthcare Hospitals IRS Non-Profits

President Signs Tax Bill with Medicare Provisions, Ebola Treatment/Vaccine Bill

In December 2014, President Obama signed into a law H.R. 5771, a tax extender bill that includes the “Achieving a Better Life Experience (ABLE) Act of 2014.” ...more

1/22/2015 - ABLE Act Barack Obama Ebola ESRD FDA New Legislation Tax Extenders

Analysis of HHS OIG Proposed Rule to Amend the Anti-Kickback Safe Harbors, CMP Rules on Beneficiary Inducements & Gainsharing...

On October 3, 2014, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) published a major proposed rule that would amend the safe harbors to the Anti-Kickback Statute (AKS) and the Civil...more

10/22/2014 - Affordable Care Act Ambulance Providers Anti-Kickback Statute CMP Law Gainsharing Hospitals OIG Pharmacies Physicians Proposed Regulation Public Comment Rulemaking Process Safe Harbors

Analysis and Impact of the Improving Medicare Post-Acute Care Transformation Act of 2014

This week, President Obama signed into law the Improving Medicare Post-Acute Care Transformation Act of 2014 (the “IMPACT Act” or “Act”). The IMPACT Act’s provisions will affect a broad range of post-acute care (“PAC”)...more

10/9/2014 - Barack Obama Home Health Care IMPACT Act Inpatient Rehab Facilities Long Term Care Facilities Medicare New Legislation Quality of Care Standards Reporting Requirements Skilled Nursing Facility

President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

In This Issue: - One-Year Medicare Physician Fee Schedule Fix - Valuation of Services Under the Physician Fee Schedule - ICD-10 Delay; LTCH Moratorium to Become Effective Immediately - Skilled Nursing...more

4/8/2014 - Barack Obama Long-Term Care Medicaid Medicare Physician Fee Schedule SNF

ACA Affordable Insurance Exchanges and Qualified Health Plans

In This Issue: Exchanges and Types of Plans To Be Offered Through Exchanges; Essential Health Benefits; Premiums; Cost Sharing Reductions; and Other Issues. Excerpt from Exchanges and Types of Plans To Be...more

3/15/2013 - Affordable Care Act Essential Health Benefits Health Insurance Exchanges Healthcare Premiums Qualified Health Plans Reinsurance SHOP Program

Medicare and Sequestration – What Happens Now?

Due to continuing budget gridlock in Washington, sequestration has been triggered – meaning automatic cuts to a wide range of federal programs, including Medicare payments to providers and health plans. While the Centers for...more

3/5/2013 - CMS Healthcare HHS Medicare OMB Sequestration Spending Cuts

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