Centers for Medicare & Medicaid Services

News & Analysis as of

A (Second) Lawsuit Seeks to Compel Statutory Timeframe for Administrative Law Judge Review of Medicare Claims Appeals

On August 26th, the Center for Medicare Advocacy filed a nationwide class action lawsuit against the Secretary of Health and Human Services. The complaint alleges that, as implemented, the Medicare administrative review...more

CMS Offers Global Settlement of Inpatient Status Claims with Pending Appeals

On August 29, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced a global settlement offer to acute care and critical access hospitals with currently pending appeals of inpatient status claims denials....more

A Primer on Medicare Requirements for Physician Supervision of "Incident to" Services

Services provided by a physician’s auxiliary staff that are “incident to” the physician’s services are paid under the physician fee schedule at a higher rate, as though the physician had personally furnished the services....more

Health Headlines: Also in the News - September 2014

GAO Finds CMS Should Fully Develop Plans for Medicare Advantage Encounter Data and Assess Data Quality Before Use – In a report released on September 2, 2014, GAO evaluated CMS’s plans for using Medicare Advantage (MA)...more

Fire Safety Requirements for Hospitals and Other Health Care Facilities: How CMS Is Interpreting Occupancy Classifications and...

On April 16, 2014, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule amending the fire safety standards for hospitals and other types of health care facilities. Compliance with the fire safety...more

Is CMS Feeling the Sunshine Heat? – Part 2

As follow-up to our recent post on the issues that the Centers for Medicare & Medicaid Services (CMS) is experiencing with its Open Payments database, there is new information that additional data also may be excluded when...more

Medicare Bundled Payments Initiative and Oncology Care

According to Modern Healthcare’s “Interest Surges in Medicare Bundled Payment Initiative” article on July 31, 2014, enthusiasm for bundled pricing has been associated with the Medicare Bundled Payments for Care Improvement...more

CMS Issues Final Rule on Marketplace Auto-Enrollment

On September 5, 2014, the Centers for Medicare and Medicaid Services (CMS) published a final rule, effective October 6, 2014, that, among other things, specifies the auto-enrollment process for consumers who receive health...more

Health Care Update - September 2014

In This Issue: - HealthCare.gov Hacking Breach - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other Health...more

Health Law Blog: CMS Offers Settlement to Hospitals for Resolving Patient Status Denials

On September 9, 2014, the Centers for Medicare & Medicaid Services (CMS) held a conference call with providers and other interested parties regarding CMS’s recent offer to resolve any acute care or critical access hospitals’...more

CMS Approves Pennsylvania’s Medical Assistance (Medicaid) Waiver

CMS approved Pennsylvania’s Medical Assistance (“Medicaid”) waiver request entitled Healthy Pennsylvania (“Waiver” or “Healthy Pennsylvania”) by letter dated August 28, 2014. Governor Tom Corbett and the Pennsylvania...more

Pennsylvania gets a green light to pursue Medicaid expansion under an alternative model

The Centers for Medicare and Medicaid Services (CMS) has approved Pennsylvania’s demonstration proposal to expand Medicaid to adults with incomes through 133 percent of the federal poverty line. The state is the 28th...more

CMS Offers Deal to Hospitals to Drop RAC Appeals

On August 29, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a deal to hospitals willing to drop pending inpatient-status claims appeals. These appeals have grown exponentially in recent years due to the...more

Final Guidance on 2014 Certified EHR Technology Requirements and Implementation of Stage 3 Meaningful Use Requirements

On September 4, 2014, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the National Coordinator for Health Information Technology (“ONC”) issued a final rule (the “Final Rule”) that adopts, without...more

News from the Health Law Gurus™

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every week for the latest health law news stories....more

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

Federal Court Rejects Challenge to new CMS Recovery Auditor Contracts

On August 22, 2014, the U.S. Court of Federal Claims denied a challenge by incumbent Recovery Audit Contractor (RAC) CGI Federal, Inc. (CGI) to CMS’s plan to award new RAC contracts. Among other things, the Court found that...more

CMS Says: Let's Make a Deal

In the hours before everyone began enjoying Labor Day Weekend, the Centers for Medicare & Medicaid Services (CMS) issued an important inpatient hospital review update....more

CMS Issues Final Rule on Hospice Wage Index and Payment Rate Update for FY 2015

On August 4, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the hospice wage index and payment rate for Fiscal Year (FY) 2015 and adopting a number of payment reforms addressing concerns...more

Special (Limited) CMS Offer to Settle Claims on Appeal

With little fanfare just before the Labor Day weekend, CMS announced a program in which it would enter into administrative agreements with eligible providers in exchange for the providers’ withdrawal of pending appeals...more

CMS Issues Final Rule for Inpatient Stays in Acute Care and Long Term Care Hospitals

On August 1, 2014, the Centers for Medicare and Medicaid Services (CMS) issued its annual final rule for policy and payment changes applicable to inpatient stays in acute care and long term care hospitals (Final Rule). This...more

Manatt on Medicaid: Pennsylvania Receives Federal Approval to Implement Medicaid Expansion

On August 28, 2014, the Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s application under Section 1115 of the Social Security Act to implement a Medicaid expansion effective January 1, 2015, through a...more

CMS, ONC Adopt EHR Standards Flexibility for Eligible Providers; Delay Start of Stage 3

On August 29, 2014, CMS and the Office of the National Coordinator for Health IT (ONC) issued a final rule adopting the agencies’ proposal to grant flexibility for eligible providers regarding which edition of certified EHR...more

Another Pioneer Leaves The West

Another withdrawal from the Medicare Pioneer Accountable Care Organization (ACO) program has occurred. Sharp Healthcare ACO, an affiliate of the Sharp integrated delivery system in San Diego, California, notified the Center...more

Is CMS Feeling the Sunshine Heat?

As we told you about here, the Centers for Medicare & Medicaid Services (CMS) has been dealing with issues related to its Open Payments database of payments and transfers of value reported by manufacturers and group...more

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