Centers for Medicare & Medicaid Services

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Manatt on Health Reform: Weekly Highlights: November 2014 #2

With the conclusion of the midterm elections last week and open enrollment just around the corner, this week’s news highlights both renewed pledges from the opposition and a flurry of implementation activity in the states....more

ACO Fraud and Abuse Waivers Extended Through November 2, 2015

On October 17, 2014 the Centers for Medicare and Medicaid (CMS) and Office of Inspector General (OIG) within the Department of Health and Human Services published a continuation notice in the Federal Register extending the...more

Hospitals Should Be Aware of ACA Requirement to “Make Public” Their “Standard Charges”

A provision of the Affordable Care Act includes a requirement that hospitals disclose their standard charges to the public. 42 U.S.C. § 300gg-18(e) states that “[e]ach hospital operating within the United States shall for...more

CMS Updates Manual Instructions to Implement CY 2014 MPFS Changes for Reimbursement of Investigational Devices and Related...

On November 6, 2014, CMS announced changes to its Medicare Benefit Policy Manual and Medicare Claims Processing Manual related to coverage of items and services in Category A and B Investigational Device Exemption (IDE)...more

Health Care Reform Implementation Update

Over the past several days, the second open enrollment period through the Affordable Care Act’s (ACA’s) health insurance exchanges began; Republican lawmakers, now with majorities in both the House and the Senate, explored...more

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

Dialysis Facility Compare Star Ratings and Data Release – CMS has finalized its methodology for its Dialysis Facility Compare Star Ratings program and expects to post ratings to Dialysis Facility Compare in January...more

Do You Have A Health Plan Identifier?

Do You Even Know What It Is? With great focus on healthcare reform, you may have missed a current requirement for health plans to apply for and obtain a Health Plan Identifier (HPID). This requirement does not come...more

CMS Will Refresh Sunshine Act Data by December 31, 2014

During the 15th Annual Pharmaceutical Compliance Congress and Best Practices Forum on November 4, 2014, Douglas Brown, Deputy Director of the Data Sharing & Partnership Group within CMS’s Center for Program Integrity,...more

Highlights of the 2015 OPPS and ASC Final Rule

On October 31, 2014, CMS published its 2015 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule. This annual rule affects the 4,000...more

Attention All You Procrastinators!

The Centers for Medicare and Medicaid Services (CMS) has postponed to 11:59 pm on December 5, 2014, the deadline for health insurance issuers and self funded plans to submit their annual enrollment count for the transitional...more

CMS Finalizes Several Changes for Skin Substitutes in CY 2015 Outpatient Prospective Payment System Final Rule

On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) released its annual final rule (Final Rule) setting the payment rates and coverage policies for items and services reimbursed under the Outpatient...more

CMS Releases Final Physician Fee Schedule Rule: Key Payment and Policy Highlights

On October 31, 2014, CMS released the final Medicare physician fee schedule (PFS) rule. The new payment policies and rates set forth in the PFS final rule will go into effect on or after January 1, 2015....more

CMS Finalizes 2015 Home Health Prospective Payment System Rule

The Centers for Medicare & Medicaid Services (CMS) published the annual final rule on the Medicare home health prospective payment system (HH PPS) rates for calendar year (CY) 2015 in the November 6, 2014, Federal Register...more

Health Headlines: Also in the News - November 2014

CMS announced a revision to the effective date of cost reporting requirements for certain providers. Under Transmittal 8, the new requirements affect cost reporting periods ending on or after September 30, 2014, rather than...more

CMS Instructs MACs to Participate in ALJ Hearings

CMS officially added a new Section 3.9 to the Medicare Program Integrity Manual, effective October 27, 2014. These provisions instruct Medicare Administrative Contractors (MACs) to assign a physician to participate at...more

HHS Seeks Public Input To Address Growing Backlog of Medicare Appeals

The Office of Medicare Hearings and Appeals (OMHA), a division of HHS that administers the Administrative Law Judge (ALJ) hearing program for Medicare claims appeals, recently issued a Request for Information (RFI) seeking...more

Blog: CMS Explains New Data Matching and Resubmission Process During Open Payments Webinar Today

The Centers for Medicare and Medicaid Services (CMS) held a webinar today to address the process for correcting and resubmitting records that were removed from the Open Payments system in August 2014 by CMS due to data...more

CMS Finalizes Proposal to Remove Continuing Medical Education Exclusion from Sunshine Act Regulations

On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its final Medicare physician fee schedule rule for CY 2015 (the Final Rule), which also includes certain changes to the Sunshine Regulations. ...more

CMS Announces Indefinite Delay in Use of HPID

All Actions as to HPIDs Should Stop. With a November 5, 2014 deadline looming for large health plans to obtain a Health Plan Identifier (HPID), the Centers for Medicare & Medicaid Services (CMS), Office of e-Health Standards...more

Post-Acute Care Summary Report - 2014: Benesch Health Care Market Intelligence

In this Issue: - Key Findings - Subsector Activity - Regulatory/Legal - Reimbursement - Excerpt from Key Findings: • The post-acute care (PAC) sector has seen an increase in mergers...more

CMS Issues 2015 ESRD and DMEPOS Final Rule

On October 31, 2014, CMS issued a final CY 2015 End-Stage Renal Disease (ESRD) PPS and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) final rule. CMS finalized its proposal to increase overall ESRD...more

SRDP No Longer New Wine

More than four years after the Centers for Medicare & Medicaid Services' (CMS) issuance of the Stark Self-Referral Disclosure Protocol (SRDP), it's time to assess the results. The SRDP was designed by Congress to resolve...more

CMS Announces CY 2015 Home Health Prospective Payment System Rates

On October 30, 2014, CMS issued a final rule for Medicare Home Health Prospective Payment System (HH PPS) rates for CY 2015. The final rule estimates that Medicare payments to home health agencies (HHAs) in CY 2015 will be...more

Health Care Reform Implementation Update

Looming midterm elections have made the past several months difficult for Democrats and Republicans alike when it comes to the Affordable Care Act. With most of the midterm elections now wrapped up, lawmakers can turn their...more

OIG Releases Its Workplan for 2015

HHS’s Office of Inspector General (OIG) released on Friday its Work Plan for fiscal year (FY) 2015. The 94-page work plan summarizes the new and ongoing reviews and activities that OIG plans to pursue across the full spectrum...more

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