Leslie Demaree Goldsmith

Leslie Demaree Goldsmith

Ober|Kaler

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CMS Proposes Limited Exception to Two-Midnight Rule and QIO Review of Short Stays

In the 2016 inpatient prospective payment system (IPPS) proposed rule, CMS promised to provide further guidance on the controversial "two midnight" rule in the forthcoming outpatient prospective payment system (OPPS) rule....more

7/31/2015 - CMS Exceptions IPPS MACs QIOs Two-Midnight Rule

CMS Issues CY 2016 Proposed Rule for OPPS, ASC Payment Systems and Quality Reporting

On July 8, 2015, CMS published in the Federal Register [PDF] its proposed changes and updates to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy...more

7/30/2015 - CMS Health Care Providers Healthcare Hospitals OPPS Patient Prospective Payment System Proposed Regulation Two-Midnight Rule

CMS Pays $1.3 Billion to Hospitals for Settlements of Medicare Inpatient Appeals

On June 11, 2015, CMS announced that it had entered into settlements with over 1,900 hospitals for over 300,000 disputed inpatient billing claims. CMS updated its website dedicated to inpatient hospital reviews, noting that...more

6/27/2015 - CMS Healthcare Hospitals Inpatient Billing Medicare Settlement Agreements

CMS Issues DSH Ruling 1498-R2

CMS recently issued Ruling 1498-R2 (Ruling), dated April 22, 2015, amending its 2010 Ruling 1498-R. The new Ruling addresses the calculation of the Medicare fraction of the disproportionate share hospital (DSH) adjustment for...more

5/5/2015 - CMS DSH Adjustments MACs Medicare Medicare Part A PRRB Ruling 1498-R

"Next Generation" ACO Model Announced by CMS

In a March 10, 2015 press release, CMS announced a new addition to its existing Accountable Care Model (ACO) portfolio: Next Generation ACOs. As stated by CMS in its press release, this new ACO model will allow for already...more

4/9/2015 - ACOs Affordable Care Act CMS HHS Next Generation ACO (NGACO) Request for Application (RFA)

Beginning April 1, HHA Payment Will Be Determined By CMS Generated Code Using OASIS Data

Payment for a particular home health agency (HHA) beneficiary’s episode of care is based on a Health Insurance Prospective Payment System (HIPPS) code. There are three sources for the HIPPS code and they do not always agree:...more

3/5/2015

CMS Proposes Changes to the Medicare Shared Savings Program MSSP

On December 1, 2014, CMS published its proposed changes and updates to the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). Comments are due by February 6, 2015. Below is a summary of the...more

1/9/2015 - ACOs CMS Healthcare Medicare Medicare Shared Savings Program Proposed Amendments

Highlights of the 2015 Home Health Prospective Payment Rule

On November 6, 2014, CMS published its final Medicare home health prospective payment system (HH PPS) rule for calendar year (CY) 2015. As highlighted below, notable changes in the HH PPS final rule [PDF] include: (1) a...more

12/16/2014 - ACOs CMS Healthcare Home Health Care Patient Prospective Payment System

CMS Releases Final Physician Fee Schedule Rule: Key Payment and Policy Highlights

On October 31, 2014, CMS released the final Medicare physician fee schedule (PFS) rule. The new payment policies and rates set forth in the PFS final rule will go into effect on or after January 1, 2015....more

11/17/2014 - CMS Final Rules Physician Medicare Reimbursements

CMS Releases New, Proposed Home Health Conditions of Participation

CMS published a proposed rule on Thursday, October 9th, 2014, updating the Home Health Agency (HHA) Conditions of Participation (CoPs). The proposed rule represents the first update to the HHA CoPs since 1989. Comments are...more

10/21/2014 - CMS Healthcare Home Health Agencies Medicare Participation Standards Proposed Standards

Court Affirms CMS's Adjustments to Wage Index

Deferring to CMS, the United States Court of Appeals for the Sixth Circuit recently upheld the agency’s treatment of hospitals’ payments to employees for wage index purposes. Atrium Medical Center v. U.S. Dept. of Health &...more

10/6/2014 - Appeals CMS Employer Liability Issues Hospitals Wages

OMHA Announces Two New Programs to Process Administrative Law Judge (ALJ) Hearings More Efficiently

Earlier this year, the Office of Medicare Hearings and Appeals (OMHA) announced that for most hearing requests received after April 1, 2013, it will be deferring assignment of ALJs. OMHA’s announcement is available on its...more

8/21/2014 - Administrative Hearings ALJ Mediation OMHA Statistical Sampling

CMS Publishes Proposed 2015 OPPS and ASC Payment Rule

On July 3, 2014, CMS posted the proposed CY 2015 outpatient perspective payment system (OPPS) and Ambulatory Surgical Center (ASC) payment rule, which was subsequently published in the Federal Register on July 14, 2014 [PDF]....more

7/25/2014 - CMS Healthcare Healthcare Facilities Hospitals OPPS Reimbursements Rulemaking Process

AMA Issues Telemedicine Guidelines

On June 11, 2014, the American Medical Association (AMA) released a new set of telemedicine principles, which emerged from its policy report addressing “Coverage and Payment for Telemedicine.” The AMA report details the...more

7/15/2014 - American Medical Association CMS Healthcare Reimbursements Telemedicine

CMS Announces Provider Relations Coordinator for RAC and MAC Issues

CMS recently announced that it has established a CMS Provider Relations Coordinator, Latesha Walker, to assist providers in resolution of issues with Recovery Auditor Contractors (RACs) and Medicare Administrative Contractors...more

7/11/2014 - Administrative Appointments CMS MACs RACs

HHS to Continue Enforcing Orphan Drug Exclusion from 340B Program

The Department of Health and Human Services (HHS) through its Office of Health Resources and Services Administration (HRSA) announced last week that, although a court recently struck down its regulation addressing application...more

6/30/2014 - Covered Entities HHS HRSA Orphan Drugs Pharmaceutical PHRMA Prescription Drugs Section 340B

Proposed Hospice Rule Focuses on Unbundling of Services

On May 8, CMS released a proposed rule in the Federal Register providing for a payment increase of 1.3 percent for fiscal year (FY) 2015. Among other provisions, CMS’s proposed rule offers hospice providers an update on...more

6/13/2014 - Bundling Rules CMS Healthcare Hospice Medicare Medicare Part D

PRRB Issues Alert Requiring Supplementation of Record in DSH Cases

Recently, on May 23, the Provider Reimbursement Review Board (PRRB) issued its latest alert, Alert 10 (Alert), in an email blast. As of the writing of this article, the Alert had not been posted on the PRRB’s website....more

6/4/2014 - DSH Healthcare Medicaid Medicare PRRB

CMS's Proposed Adoption of New Geographic Areas Likely to Have Significant Reimbursement Effects

In its proposed FY 2015 inpatient prospective payment system (IPPS) rule, CMS asserts its intent to adopt the most recent labor market area delineations issued by the Office of Management and Budget (OMB), which utilize 2010...more

5/21/2014 - CBSA Census CMS Healthcare IPPS OMB Public Comment

AHA Challenges to the Two-Midnight Rule - Preserve Your Hospital's Right to Challenge

The American Hospital Association (AHA), along with several state and regional hospital associations and several hospitals, recently filed two lawsuits challenging CMS’s two-midnight rule and related policies....more

5/6/2014 - American Hospital Association CMS Healthcare Hospitals Two-Midnight Rule

Medicare Bad Debt: Courts Again Uphold HHS's Stringent "Must Bill" Policy Requirements

On March 25, 2014, the United States District Court for the District of Maine upheld the decision of the Department of Health and Human Services (HHS) to withhold from Maine Medical Center (MMC), Medicare reimbursement for...more

5/5/2014 - Healthcare HHS Medicare

CMS's New System of Records for the Hospice Quality Reporting Program

On April 8, 2014, CMS published in the Federal Register a “Notice of a New System of Records (SOR).” CMS is establishing a new SOR titled, “Hospice Item Set System” (or HIS). ...more

4/28/2014 - CMS Healthcare Hospice

Maryland Health Care Commission Proposes to Extend and Revise EHR Incentive Regulations

On March 21, 2014, the Maryland Health Care Commission (MHCC) published proposed revisions to the existing Maryland Electronic Health Record Incentives regulations at COMAR 10.25.16. The proposed regulations [PDF] would...more

4/25/2014 - CMS EHR Healthcare Incentives Physician Payments

Upcoming PQRS Deadlines

If you are submitting PQRS data, please make note of the following upcoming deadlines this month: March 21, 2014: - Last day for groups to submit 2013 data through the GPRO Web Interface webpage...more

3/24/2014 - Deadlines PQRS

CMS Posts Guidance on Two-Midnight Rule and Related Audits

On February 24, 2014, CMS posted a list of updates to its guidance on the new Two-Midnight Rule and the Probe and Educate Audits. Several of the more major updates are discussed below....more

3/12/2014 - Audits CMS Healthcare MACs Medicaid Medicare

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