Monica Wallace

Monica Wallace

McDermott Will & Emery

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CMS Increase in Mandated Nursing Facility CMPs

The Centers for Medicare & Medicaid Services (CMS) recently published a letter to State Survey Agency Directors describing revisions to Chapter 7 of the State Operations Manual (SOM) to reflect mandatory disciplinary...more

9/13/2016 - Civil Monetary Penalty CMS Enforcement Skilled Nursing Facility

New Medicare Enrollment Requirements for MA Providers

In Depth - The Medicare Physician Fee Schedule proposed rule released by the Centers for Medicare & Medicaid Services (CMS) on July 7, 2016, (the Proposed Rule) requires certain providers and suppliers furnishing health...more

7/26/2016 - CMS Enrollment General Services Administration (GSA) Medicaid Medicare Medicare Advantage Medicare Advantage Organizations (MAOs) Medicare Part D OIG Physician Fee Schedule Prescription Drug Coverage

CMS Proposed Rule Implements Limitations on Medicare Payments for Off-Campus Outpatient Hospital Departments

In Depth - Background - On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the CY 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule, which includes proposed regulations to...more

7/12/2016 - Ambulatory Surgery Centers Bipartisan Budget Act CMS Comment Period Hospitals Medicare MPFS Off-Campus Departments OIG OPPS Payment Systems Physician Fee Schedule Proposed Rules Section 340B

OIG Issues Report on Provider-Based Facilities, Urges CMS to Make Changes

In Depth - On June 16, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) posted a report examining the Centers for Medicare & Medicaid Services’ (CMS’s) oversight of billing by...more

6/28/2016 - CMS HHS Hospitals MedPAC OIG Provider Payments

Program Integrity Changes to the Medicare Provider Enrollment Process

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

3/11/2016 - Affordable Care Act Billing CHIP CMS DMEPOS Enrollment Healthcare Medicare Overpayment Provider Payments

CMS Finalizes Prior Authorization Program for Certain DMEPOS Items

On December 30, 2015, the Centers for Medicare & Medicaid Services (CMS) published its final rule establishing a prior authorization program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS)...more

1/8/2016 - CMS DMEPOS Durable Medical Equipment Final Rules Medicare Prior Authorization Provider Payments

Congress Take Step Toward Site-Neutral Medicare Payments in Bipartisan Budget Act of 2015

On October 28, 2015, the U.S. House of Representatives approved legislation that, if enacted, would, among other things, substantially alter how and how much Medicare pays for outpatient services furnished by hospitals. The...more

10/30/2015 - Ambulatory Surgery Centers CMS Debt Ceiling Federal Budget Generic Drugs Health Care Providers Healthcare Hospitals HRSA Medicaid Medicare Medicare Part B OPPS Pending Legislation Physician Fee Schedule Physicians Prescription Drugs Rebates Section 340B Sequestration

CMS Issues Proposed - Skilled Nursing Facility Rule

On April 15, 2015, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to address Skilled Nursing Facility (SNF) Medicare rate increases for fiscal year (FY) 2016, as well as to propose a variety of measures...more

4/24/2015 - CMS Healthcare Medicare Skilled Nursing Facility

CMS Proposes Rule to Expand Authorization Program, Solicits Comments on Implementation

On May 28, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) published a proposed rule to establish a prior authorization process for certain durable medical equipment,...more

6/17/2014 - CMS DMEPOS Durable Medical Equipment Healthcare HHS Prior Authorization Social Security Act

OIG Proposes Rule to Expand Civil Monetary Penalties and Solicit Comments on Penalty for Failure to Report and Return Overpayments...

Department of Health and Human Services, Office of Inspector General’s (OIG) proposed rule expands the use of civil monetary penalties and solicits comments on the penalty for failure to report and return overpayments. ...more

5/29/2014 - Civil Monetary Penalty CMS Healthcare HHS OIG Overpayment

CMS to Postpone Denying Claims When Ordering/Referring Provider Not Enrolled in Medicare

The Centers for Medicare & Medicaid Services will implement edits on providers ordering/referring Part B, durable medical equipment and Part A home health agency claims effective January 6, 2014....more

12/3/2013 - CMS Denial of Benefits Medicaid Medicare

CMS Delays Edits to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare and Issues Proposed Rule on Enrollment...

The Centers for Medicare & Medicaid Services temporarily delayed the implementation of edits relating to ordering/referring practitioners that were scheduled to go into effect May 1, 2013, and issued a proposed rule with...more

5/13/2013 - Billing CMS Medicare

CMS to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare

Effective May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will begin to deny Part B Durable Medical Equipment (DME) and Part A Home Health Agency (HHA) claims for services or supplies when the...more

3/20/2013 - CMS Durable Medical Equipment Home Health Agencies Medicare

Overview of 2013 Final Rule on DME Written Order and Face-to-Face Encounter Requirements

In the 2013 Medicare Physician Fee Schedule final rule, the Centers for Medicare & Medicaid Services significantly expands the list of durable medical equipment (DME) items that will require a face-to-face encounter and...more

11/14/2012

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