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Beneficiaries Hospitals

King & Spalding

Federal Court Sides with Hospitals in Dispute Over Medicare Payment for Nursing and Allied Health Programs

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On February 9, 2024, Judge Trevor McFadden of the United States District Court for the District of Columbia issued a decision holding that CMS miscalculated the Medicare reimbursement owed to five plaintiff hospitals for the...more

McDermott Will & Emery

CMS Streamlines Medicare Enrollment and Standardizes Nondiscrimination Language

In late January 2023, the Centers for Medicare and Medicaid Services (CMS) issued two updates relevant to provider and supplier organizations enrolled in Medicare: (1) a redesign to the Provider Enrollment, Chain and...more

Sheppard Mullin Richter & Hampton LLP

How Broad is the Managed Care Safe Harbor?

In Advisory Opinion No. 18-11, the Department of Health and Human Services Office of the Inspector General (the “OIG”) addressed a Medicaid managed care organization’s (“MCO”) proposal to pay its contracted providers and...more

Chambliss, Bahner & Stophel, P.C.

Seniors Often Must Fight for Medicare Home Health Benefits

Medicare is mandated to cover your home health benefits with no limit on the time you are covered. Unfortunately, few Medicare beneficiaries get the level of service they are entitled to, and many find their services cut off...more

Holland & Knight LLP

Healthcare Law Update: May 2018

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Enforcement - OIG Issues Advisory Opinion on Provision of Samples by a Device Distributor - On April 30, 2018, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a...more

Foley & Lardner LLP

Two Recent Examples of Challenges To Collect “Reasonable” Charges

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Two recent cases illustrate the continuing challenges providers, and in particular hospital providers, face when seeking to collect their charges when dealing with “out-of-network” patients....more

King & Spalding

District Court Allows Medicare Beneficiary Class Action to Proceed

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On February 8, 2017, the United States District Court for the District of Connecticut declined to fully dismiss allegations filed by a class of Medicare patients against HHS in Alexander et al. v. Cochran (formerly Bagnall et...more

Baker Donelson

The MOON Notification is Coming: CMS Publishes Final Changes

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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

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Arnall Golden Gregory LLP

GAO Recommends Congress Reduce Incentives for Prescribing 340B Drugs

The United States Government Accountability Office (GAO) recently released a report entitled “Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals” (“the...more

Foley & Lardner LLP

Beneficiary Assignment Under the MSSP Final Rule

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This is the fourth post in Health Care Law Today’s series on the final rule. This post addresses how CMS assigns beneficiaries to an ACO participating in the MSSP. In the MSSP ACO Final Rule, CMS finalized new...more

King & Spalding

Misprint in Beneficiary Copayment Amount for Hospital Clinic Visits

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CMS has reportedly erred in publishing a 40 percent beneficiary copayment amount for hospital outpatient clinic visits beginning in CY 2014. According to information provided by CMS to one of our clients, the beneficiary...more

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