Centers for Medicare & Medicaid Services

News & Analysis as of

AHA Responds to Proposed Home Health Face-to-Face Changes

As previously reported, on July 7, 2014, CMS issued the Calendar Year 2015 Home Health Prospective Payment System Proposed Rule (Proposed Rule). On August 18, 2014, the American Hospital Association (AHA) submitted comments...more

Health Care Reform Implementation Update August 2014

The Centers for Medicare and Medicaid Services (CMS) made announcements this week regarding the Open Payments system and the availability of Affordable Care Act (ACA) Consumer Assistance Program grant funds, issued a request...more

AHRQ Releases Guidance for Reductions in Medicaid Hospital Readmissions

The Agency for Healthcare Research and Quality (AHRQ) has issued a comprehensive guide with an interactive toolkit for providers to target reductions in Medicaid hospital readmissions. While numerous CMS initiatives have...more

Health Care: Charting the Path Forward to DSRIP for Long-Term Care Providers (8/14)

Designed by New York State to seek a federal waiver for the expenditure of Medicaid funds, the Delivery System Reform Incentive Program (DSRIP) will allocate 6.42 billion dollars to health care providers in New York State to...more

New Federal Guidance on Reducing Medicaid Hospital Readmissions

The Agency for Healthcare Research and Quality (AHRQ) recently issued a guide to assist hospitals in reducing Medicaid patient readmissions. The AHRQ Hospital Guide to Reducing Medicaid Readmissions is the product of a...more

Sunshine Act Implementation Proceeds; CMS Re-opens the Open Payments System

On August 15, 2014, the Centers for Medicare and Medicaid Services (CMS) re-opened the Open Payments system for physicians and teaching hospitals to register, review, and, if needed, dispute information gathered to date. CMS...more

CMS Reopens Open Payments System, Extends Review/Dispute Period and 15-Day Correction Period

On Friday, August 15, 2014, CMS officially announced the reopening of its Open Payments system and an extension of the covered recipient review/dispute period and subsequent data correction period. Our understanding is that...more

FDA Approves Cancer Screening Test as First Device Under Parallel Review Pilot

On August 11, 2014, the Food and Drug Administration (FDA) issued a premarket approval (PMA) for Exact Sciences’ Cologuard, a colorectal cancer screening test, and the Centers for Medicare & Medicaid Services (CMS) issued a...more

Court Enjoins CMS From Enforcing Dissatisfaction Requirement When a Provider’s Appeal Stems from the MAC’s Failure to Issue a...

On August 6, 2014, the United States District Court for the District of Columbia enjoined CMS, its Medicare Administrative Contractors (MACs), and the Provider Reimbursement Review Board (PRRB) from applying the...more

Overview of the FY 2015 IRF Final Rule

On August 6th, the Centers for Medicare and Medicaid (CMS) published an Inpatient Rehabilitation Facility (IRF) final rule [PDF] in the Federal Register outlining (1) new Medicare payment policies and rates; and (2) guidance...more

FDA to Strengthen Oversight of Certain In Vitro Diagnostic Devices

In the wake of a new Medicare reimbursement framework, FDA plans stricter regulation of some in vitro diagnostic devices. On July 31, 2014, the U.S. Food and Drug Administration (FDA; Agency) announced its intent to...more

Here Comes the Sunshine Act

The Centers for Medicare and Medicaid Services (CMS) released a guide for physicians to prepare for the Dispute Resolution period of the Physician Payments Sunshine Act. The CMS guide is available on the CMS Open Payments...more

Who Audits the Auditors?

Since the advent of Medicare in 1965, hospitals have bemoaned the cost and burden of Medicare audits. The complaints increased when CMS hired private contractors for the audits. They became deafening in 2009 with the advent...more

Health Headlines: Also in the News - August 2014 #2

CMS Issues Final FY 2015 Hospice Wage Index and Payment Rate Update – On August 4, 2014, CMS released the Final Hospice Wage Index and Payment Rate Update for FY 2015. ...more

GAO Concludes CMS Should Increase Oversight of Post-Payment Claims Review Process

The Government Accountability Office (GAO) has released the findings of its study of the steps taken by CMS to prevent Medicare contractors from conducting certain duplicative post-payment claims reviews. Based on its audit,...more

CMS Paying Some Providers’ Medicare EHR Incentive Payment Using Incorrect Transition Factor

We have learned that CMS has paid Medicare EHR Incentive Program Payments to some eligible hospitals using an incorrect transition factor, understating total payment. CMS personnel have informed us that they are aware of this...more

CMS Care Coordination Payments – A Boon to Doctors and Patients but Patient Participation Will be Essential

As the Affordable Care Act continues to mature, we are seeing new efforts by the Obama administration to incentivize care coordination across a spectrum of services provided to Medicare Fee-for-Service (FFS) patients. A New...more

CMS Temporarily Suspends Open Payments System

On August 7, 2014, CMS announced via email that it has temporarily suspended the Open Payments system “to investigate a reported issue.” Although CMS did not offer further explanation, our understanding is that the system has...more

CMS Reopens Open Payments System After Rejecting One-Third of Reported Payments

The Centers for Medicare & Medicaid Services (CMS) announced last week that the Open Payments system was available again after it was taken off-line on August 3, 2014 to “resolve a data integrity issue.” Because the Open...more

CMS Re-Opens Open Payments System

As my colleague Brian Dunphy previously reported, CMS temporarily closed the Open Payments system earlier this month. Open Payments is the online system through which pharmaceutical and device manufacturers covered by the...more

Limited Restart of RAC Program

On August 4, 2014, CMS announced that, due to the continued delay in awarding new Recovery Audit Contractor (RAC) contracts, CMS will modify its current RAC contracts to allow for a limited number of reviews of Medicare...more

Maine Workers' Compensation Alert: CMS Guidelines Amended to Accept WCB Settlement Determination of MSA Amount After Hearing on...

The Center for Medicare and Medicaid Services (CMS) update to its Workers' Compensation Medicare Set-Aside (WCMSA) Arrangement Reference Guide provides authority by which CMS will now recognize and defer to a Workers'...more

CMS Releases FY 2015 Hospital Inpatient Prospective Payment System (IPPS) Final Rule

On August 4, 2014, CMS released the annual Hospital Inpatient Prospective Payment System Final Rule for FY 2015 (the “Final Rule”) affecting discharges occurring on or after October 1, 2014. For inpatient acute care...more

Federal Health Insurance Marketplace Sends Notices Regarding Citizenship and Immigration Data Inconsistencies

The Centers for Medicare & Medicaid Services (“CMS”) announced that the Federal Health Insurance Marketplace (“Marketplace”) began sending follow-up notices to consumers with citizenship or immigration data inconsistencies...more

CMS Shuts Down Sunshine Act Online Verification Process

On August 7, 2014, the Centers for Medicare & Medicaid Services (CMS) announced that the Open Payments system is “temporarily” off-line. The CMS announcement did not state when the Open Payments system would be back on-line....more

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