Centers for Medicare & Medicaid Services

News & Analysis as of

HHS OIG Steps Up The Pressure On SNFs And Therapy Services; Intensifies Calls For Changes To Medicare Payment System

On September 30, 2015, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its fifth report in five years on billings for therapy services in SNFs. The Medicare Payment System For...more

A Federal Ban on Arbitration Agreements in Nursing Homes? Senators’ Comment on CMS Proposed Rule Ignores Congressional Intent and...

In July, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the requirements for long-term care facilities, including implementation of new restrictions on the use of binding arbitration agreements between...more

A Recap of National Health IT Week

National Health IT Week wrapped up on Friday. This may have been the most eventful week in the ten year history of the event, which is organized by the Health Information Management Systems Society (HIMSS). Below are a few...more

The ICD-10 Switchover: It’s Here – Are You Prepared?

The day of reckoning is upon us – October 1st has now come and gone, and there was no other delay of ICD-10 implementation (the earliest proposed date of implementation was October 1, 2011, which was pushed back to October 1,...more

CMS Releases Medicare DMEPOS Payment/Utilization Data

In a continuation of the Administration’s efforts to make Medicare spending data more transparent, CMS has released detailed payment information regarding physicians and other providers who order durable medical equipment,...more

Washington Healthcare Update

On Oct. 8, the House Republican caucus did not select a candidate for Speaker of the House and selection has been delayed. The current Speaker, John Boehner (R-OH), had announced that he would step down and retire from...more

CMS and ONC Release Stage 3 Meaningful Use and EHR Certification Final Rules

On October 6, 2015, CMS released the final Stage 3 Meaningful Use Rule that, among other provisions, sets forth the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must...more

Navigating the Diagnostic Commercialization Process

Guest Post By: Perry Dimas, Senior Vice President and General Manager for Premier Source, part of AmerisourceBergen The 2015 Business of Personalized Medicine Summit was an inspiring day with talented professionals. One...more

Clinical Laboratories: Proposed Rule Implements Requirements for Reporting and Payment Based on Private Payer Rates

As required by a 2014 statute, CMS has issued proposed regulations (Proposed Rule) implementing new requirements for laboratory reporting of, and eventually basing Medicare payment on, rates for clinical laboratory services...more

GAO Assesses Considerations for Expansion of the Medicare Appropriate Use Criteria Program

On September 30, 2015, the Government Accountability Office (GAO) released a report entitled “Medicare: Considerations for Expansion of the Appropriate Use Criteria Program.” In addition to describing CMS’s plans for...more

GAO Report Calls for Enhanced Medicare Advantage Network Oversight

On September 28, 2015, the Government Accountability Office (GAO) released a report regarding CMS controls of provider adequacy in Medicare Advantage Organization (MAO) networks. The GAO pursued its review because many MAOs...more

New CMS Proposed Rule Provides Who/What/When for Clinical Laboratory Reporting Requirements Starting January 1, 2016

Clinical laboratories will see significant changes to their Medicare payments for clinical diagnostic laboratory tests (CDLTs) starting January 1, 2017, but the basis for new payment rates will come from “applicable data”...more

CMS Proposes Major Changes to Medicare Clinical Lab Test Payment Policy

On October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited proposed rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts...more

CMS Announces Medicare Part D Medication Therapy Management Innovation Model

The latest CMS “innovation model” will test whether providing Medicare Part D prescription drug plan (PDP) sponsors with financial incentives and flexibility with regard to medication therapy management (MTM) program...more

Coming Soon to a Hospital near You: Mandatory Bundled Payments for Common Surgeries

Recent action by the Centers for Medicare and Medicaid Services (CMS) announces significant change in reimbursement methodology for high volume orthopedic surgical procedures in many markets nationwide. Affected stakeholders...more

Health Law Pulse - October 2015

The Health Resources and Services Administration (HRSA) recently issued proposed omnibus guidance (Omnibus Guidance) interpreting various provisions of the 340B Drug Pricing Program (340B Program). The 340B Program allows...more

CMS Posts CY 2016 Amount in Controversy Thresholds for Medicare Appeals

CMS has published a notice announcing the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process....more

Yep, There’s a Billing Code for That

If you think you’re waiting even longer at your doctor’s office these days, you might be right. And it might be due to the overhaul of the medical billing code system that requires providers to enter an alphanumeric...more

OIG Flags $171 Million in Potentially Questionable Billing for Medicare Ophthalmology Services

The OIG has issued a report entitled “Questionable Billing for Medicare Ophthalmology Services.” The OIG concludes that most Medicare providers billing for ophthalmology services in 2012 did not demonstrate what the OIG...more

OIG Report Finds CMS’s MIDAS System Needs Improvement in Information Security Controls

On September 14, 2015, the OIG released a Public Summary Report finding that although CMS had implemented controls to secure the Multidimensional Insurance Data Analytics System (MIDAS) and consumer personally identifiable...more

Manatt on Health Reform: Weekly Highlights - October 2015

Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more

PTO Releases Report on Confirmatory Genetic Diagnostic Testing

More than three years after the June 15, 2012 deadline for providing it, the U.S. Patent and Trademark Office has issued its report on so-called "second opinion" genetic diagnostic testing, mandated by Section 27 of the...more

CMS Corrects FY 2016 Medicare Payment Rules

CMS has released corrections to a number of fiscal year (FY) 2016 final Medicare payment rules. Specifically, on October 5, 2015, CMS is publishing corrections to...more

CMS Proposes Lab Data Collection Requirements to Update Fee Schedule

On September 25, 2015, CMS released proposed rulemaking that would extensively revise payment and reporting requirements for clinical diagnostic laboratory tests (CDLTs), as paid on the Clinical Laboratory Fee Schedule...more

OIG Again Calls for Reforms to Medicare SNF Reimbursement Policy

The HHS Office of Inspector General (OIG) continues to question the appropriateness of payments to skilled nursing facilities (SNFs) under the Medicare SNF prospective payment system (PPS). Based on Medicare Part A SNF claims...more

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