Leslie Demaree Goldsmith

Leslie Demaree Goldsmith

Baker Donelson

Contact  |  View Bio  |  RSS

Latest Posts › Medicare

Share:

CMS Publishes the Medicare Outpatient Observation Notice Form and Instructions

On December 8, 2016, CMS published the final version of the Medicare Outpatient Observation Notice (MOON) that hospitals and critical access hospitals (referred collectively as "hospitals" herein) must use to provide notice...more

12/27/2016 - CMS Hospitals Medicare Medicare Outpatient Observation Notice (MOON) NOTICE Act

CMS Final Rule and 21st Century Cures Act Include Good and Bad News for Provider-Based Sites

CMS recently published its final outpatient prospective payment system (OPPS) rule, which includes its new policies governing payment related to services furnished at off-campus provider-based departments (OPBDs). 81 Fed....more

12/16/2016 - 21st Century Cures Initiative CMS Dedicated Emergency Departments Final Rules Hospitals Medicare Off-Campus Departments Outpatient Prospective Payment System (OPPS) Provider Payments Relocation

Home Health Agency PPS Update for 2017: Quality, Quality, Quality

On November 3rd, CMS published the Final Prospective Payment System (PPS) Rule for Home Health Agencies (HHAs) for CY 2017 at 81 FR 76702 (Nov. 3, 2016). The rule implements annual changes to the PPS rate for HHAs and...more

11/15/2016 - CMS Federal Pilot Programs Final Rules Home Health Agencies IMPACT Act Medicare Outlier Payments Outpatient Quality Reporting Prospective Payment System (PPS) Value-Based Purchasing

Court Rules in Favor of Hospitals in Bad Debt Collection Effort

On July 25, 2016, the United States District Court for the District of Columbia issued an opinion favoring provider flexibility in the reasonable collection of Medicare bad debt. Winder HMA, LLC, et al. v. Sylvia Burwell. The...more

10/4/2016 - Administrative Proceedings Appeals Bad Debt Business Judgment Rule Debt Collection HHS Hospitals Medicare Moratorium Provider Payments Provider Reimbursement Manual Provider Reimbursement Review Board PRRB Reversal Secretary of HHS

Court Upholds CMS's Inclusion of Part C Days in Medicare Fraction of DSH Calculation FYE 2012

On August 17, 2016, the United States District Court for the District of Columbia upheld the position of the Secretary of Health and Human Services (Secretary) that Part C patients were to be considered as “entitled to...more

10/3/2016 - Administrative Interpretation Administrative Procedure Act Disproportionate Share Adjustments HHS Hospitals Medicare Medicare Part A Medicare Part C Notice and Comment Provider Payments Remand Summary Judgment Vacated

D.C. District Court Strikes Down PRRB's Application of "Self-Disallowance" Jurisdictional

In Banner Heart Hospital, et al. v. Burwell, the United States District Court for the District of Columbia (Court) held on August 19, 2016, that the Provider Reimbursement Review Board (PRRB) incorrectly declined to hear an...more

10/1/2016 - Appeals CMS Judicial Review Jurisdiction MACs Medicare Outlier Payments Provider Payments PRRB Remand Self-Disallowance

The MOON Notification is Coming: CMS Publishes Final Changes

CMS is moving forward with implementing the Medicare Outpatient Observation Notice (MOON) as announced in its FY 2017 IPPS Final Rule [PDF] on August 2, 2016, and published in the Federal Register on August 22, 2016 (Final...more

9/21/2016 - Beneficiaries CMS Final Rules Hospitals Medicare Medicare Advantage Medicare Outpatient Observation Notice (MOON) Medicare Part A Medicare Part B NOTICE Act OMB Provider Payments

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more

9/16/2016 - Administrative Appeals Appeals CMS Health Care Providers Hospitals Inpatient Rehab Facilities IRF Claim Processing Judicial Review MACs Medicare Payment Rates Provider Payments Provider Reimbursement Review Board

CMS Releases the 2017 IPPS and LTCH PPS Final Rule, Including MOON Requirements

On August 2, 2016, CMS issued its final rule addressing new payment rates and policies under both the Hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System...more

8/26/2016 - CMS Hospitals Inpatient Prospective Payment System (IPPS) Inpatient Quality Reporting Long Term Care Facilities Medicare Medicare Outpatient Observation Notice (MOON) NOTICE Act Provider Payments

Medicare Appeals Backlog: HHS' Response to the Decade-Long Delay in Reviewing Appeals

The Department of Health and Human Services (HHS) published its proposed rule [PDF] revamping the Medicare appeals process at the Administrative Law Judge (ALJ) level on July 5, 2016. The proposed rule extensively revises...more

7/11/2016 - ALJ CMS HHS Medicare Medicare Appeals Council Medicare Claims Appeals Process OMHA

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

4/29/2016 - CMS Hospitals Inpatient Prospective Payment System (IPPS) Long Term Care Facilities Medicare Patient Prospective Payment System Proposed Regulation Provider Payments

Medicare Appeals 10-Year Backlog: D.C. Circuit Signals Enough is Enough

Issued within a month of one another, two cases regarding the Medicare appeals backlog reached opposite conclusions, providing a circuit-split. The first case from the D.C. Circuit, signaling a major shift toward judicial...more

4/1/2016 - Administrative Appeals Judicial Intervention Mandamus Petitions Medicare Split of Authority

Court Allows 'Retroactive' Application of 2005 Wage Index Rule Limiting Reimbursement for Pension Plan Costs

On February 22, 2016, in Regents of the University of California v. Burwell, the U.S. District Court for the District of Columbia granted summary judgment in favor of the Secretary of Health and Human Services (the Secretary)...more

3/21/2016 - Administrative Procedure Act Appeals GAAP HHS Hospitals Medicare Notice and Comment Pensions Provider Payments PRRB Retroactive Application Wage Index

Wage Index Reclassification Rule Struck Down by Second Circuit

On February 4, 2016, the United States Court of Appeals for the Second Circuit decided Lawrence + Memorial Hospital v. Burwell. The case addressed a regulation, issued by the Secretary of Health and Human Services...more

3/2/2016 - Chevron Deference Drug Pricing HHS Hospitals Medicare Reclassification Rules Rural Health Care Providers Wage Index

Court Upholds HHA Face-to-Face Narrative Requirement

The Medicare statute requires that home health agency (HHA) patients must be homebound and in need of skilled nursing or therapy services in order to receive Medicare HHA services. 42 U.S.C. § 1395f(a)(2)(C). Historically,...more

11/12/2015 - Affordable Care Act Chevron Deference Face-to-Face Narrative Requirement Home Health Care Medicare

The Bad Debt Moratorium Requires a Flexible Approach to Evaluating "Reasonable Collection Efforts"

On September 10, 2015, District Judge Randolph D. Moss of the U.S. District Court for the District of Columbia issued an opinion in Mountain States Health Alliance v. Burwell (Mountain States) involving Section 310 of the...more

10/28/2015 - Administrative Procedure Act Audits Bad Debt Collection Agencies HHS Medicare Moratorium Provider Reimbursement Manual Provider Reimbursement Review Board Reasonable Collection Efforts Repeal Secretary of HHS

Uncertainty Continues for Two-Midnight Rule's Payment Reduction

In Shands Jacksonville v. Burwell [PDF], No. CV 14-1477, 2015 WL 5579653, (D.D.C. Sept. 21, 2015), the United States District Court for the District of Columbia gave the Secretary of the Department of Health and Human...more

10/14/2015 - Administrative Procedure Act HHS Hospitals Inpatient Billing Medicare Notice and Comment Provider Payments Rulemaking Process Secretary of HHS Two-Midnight Rule

Home Health, CY 2016 Proposed Rule: Emphasis on Value-Based Purchasing

On July 10, 2015, CMS published the calendar year (CY) 2016 home health prospective payment system (PPS) proposed rule [PDF]. While the proposed rule updates and revises certain payment rates and quality measures, it also...more

8/25/2015 - Affordable Care Act CMS Home Health Care IMPACT Act Inpatient Quality Reporting Medicare OASIS Patient Prospective Payment System Value-Based Purchasing

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

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

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

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

41 Results
|
View per page
Page: of 2

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.
×