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Centers for Medicare & Medicaid Services (CMS) Billing

McDermott+

No Surprises Act Implementation Bumpy Period Reaches One-Year Mark

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We are now in September! And while many folks are thinking about how summer has come and gone so quickly, those following the No Surprises Act implementation process may also be wondering how a whole year has passed since the...more

King & Spalding

OIG Audit Finds Medicare Overpaid Hospitals an Estimated $79 Million for Enrollees Who Had Received Mechanical Ventilation

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On August 12, 2024, OIG announced the results of an audit of payments made to hospitals for inpatient claims with the Medicare Severity Diagnosis-Related Groups (MS-DRGs) that require ninety-six hours of consecutive...more

Health Care Compliance Association (HCCA)

[Virtual Event] Research Compliance Conference - November 12th, 8:00 am - 5:00 pm CT

Stay on top of developments in healthcare research compliance - Whether you missed the 2024 in-person Higher Education & Healthcare Research Compliance Conference in New Orleans, or are looking for additional insights...more

Spilman Thomas & Battle, PLLC

The Health Record - Healthcare Law Insights, Issue 4, August 2024

Welcome to our fourth issue of The Health Record - our healthcare law insights e-newsletter. In this edition, we address a variety of topics including a recent SCOTUS ruling and the potential impact on CMS, issues of patient...more

McDermott Will & Emery

CMS Sneaks 340B Billing Proposals into Medicare Physician Fee Schedule: What 340B Stakeholders Need to Know

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On July 10, the Centers for Medicare & Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, which includes proposals related to identification of Medicare Part B and Part D claims...more

K&L Gates LLP

Urinary Catheter Fraud Sparks Proposed Medicare Payment Changes for ACOs

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Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program got good news from The Centers for Medicare and Medicaid Services (CMS) related to widespread fraud involving urinary catheters that...more

Health Care Compliance Association (HCCA)

Compliance with Medicare’s updated 2024 split (or shared) visit policy

Split (or shared) visits—the current term used by the Center for Medicare & Medicaid Services (CMS)—allow non-physician practitioners (NPPs) and physicians who work for the same employer/entity to share patient visits on the...more

Oberheiden P.C.

What Does it Take to Win Medicare Appeals in 2024?

Oberheiden P.C. on

Lots of health care service providers find themselves in the position of needing to file a Medicare appeal. Despite the systematic nature of modern Medicare billing, wrongful denials remain common, and errors during Medicare...more

Quarles & Brady LLP

New Year, New CMS Pharmacy/DMEPOS Regulations on Refill, Deactivation, Revocation & Revalidation

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It pays to look closely. Buried deep within a 205-page and 1230-page Federal Register final rules publication, the Centers for Medicare & Medicaid Services (“CMS”) initiated impactful changes for pharmacies and Durable...more

Foley & Lardner LLP

CMS Expands Access to Behavioral Health Services; Physician Fee Schedule Expands Billing Providers and Flexibilities

Foley & Lardner LLP on

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued its 2024 Physician Fee Schedule final rule (Final Rule) for calendar year 2024 that will, in part, implement some of the most important changes...more

McCarter & English, LLP

Slow and Steady Wins the Race: Hospitals Should Evaluate Their Split/Shared Services Notwithstanding the Delay Under CMS’s 2024...

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In the CY 2024 Physician Fee Schedule Proposed Rule (the Proposed Rule), the Centers for Medicare & Medicaid Services (CMS) proposed a further delay in implementing its time-only definition for determining the “substantive...more

Butler Snow LLP

Prior Authorization Reform in Healthcare: Winds of Change?

Butler Snow LLP on

Bob Dylan, winner of the Nobel Prize in Literature and one of the greatest American songwriters of all time, has effectively used wind as a metaphor in a number of songs he has written, each with its own distinct message....more

McDermott+

McDermottPlus Check-Up: August 4, 2023

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Congress is officially in recess for the month of August and will return after Labor Day. On the regulatory front, the Centers for Medicare & Medicaid Services (CMS) released the final fiscal year (FY) 2024 Inpatient...more

McDermott+

McDermottPlus Check-Up: July 21, 2023

McDermott+ on

The House and Senate were both in session this week, with healthcare activity at the committee level. The House Energy and Commerce Committee held a hearing on innovation and a markup of 15 healthcare bills. The Senate...more

Bradley Arant Boult Cummings LLP

CMS Proposes to Continue Allowing Remote Supervision Through December 31, 2024

In its Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed rule, the Centers for Medicare and Medicaid Services (CMS) proposes to continue to allow supervising physicians and practitioners to conduct “direct...more

King & Spalding

CMS Issues Outpatient Prospective Payment System Proposed Rule for CY 2024

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On July 13, 2023, CMS published a proposed rule to update the payment policies, payment rates, and other provisions for services furnished under the Medicare Outpatient Prospective Payment System (OPPS) and the Ambulatory...more

Health Care Compliance Association (HCCA)

[Virtual Event] Clinical Practice Compliance Conference - October 10th - 11th, 9:00 am - 4:45 pm CT

Are you in a clinical setting and looking for updates on compliance trends and initiatives? Join us this October for HCCA’s Virtual Clinical Practice Compliance Conference and get insights, updates, and strategies for...more

Bass, Berry & Sims PLC

CMS Audits: Part 1 The ABCs of Medicare and Medicaid Claims Audits: Understanding the Audit Contractors

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Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more

McDermott Will & Emery

CMS Issues New Policy Allowing Medicaid and CHIP Coverage of Interprofessional Consultations

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The Centers for Medicare and Medicaid Services (CMS) has revised its policy guidance on the coverage and payment for interprofessional consultations under Medicaid and the Children’s Health Insurance Program (CHIP)....more

Benesch

CMS Adds SNFs to “High” Screening Category, Greater Scrutiny of Change of Ownership and Provider Enrollment/Revalidation

Benesch on

The Centers for Medicare and Medicaid Services (“CMS”) has effectuated multiple changes that directly impact the acquisition, development, and revalidation of skilled nursing facilities that participate in the Medicare...more

Robinson+Cole Health Law Diagnosis

OIG Issues Reports Reviewing Laboratory Billing Practices and Noting Increased Spending by Medicare Part B on Laboratory Tests

As the year comes to a close, the government has signaled a specific focus on clinical laboratories for 2023.  On December 6, 2022, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) issued...more

Rivkin Radler LLP

CMS Adds New Billing Code for Dental Surgeries

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The American Dental Association (ADA) announced on November 15 that the Centers for Medicare & Medicaid Services (CMS) has agreed to create a new Healthcare Common Procedure Coding System (HCPCS) code G0330 for dental...more

Epstein Becker & Green

Telemental Health Laws: Overview - 2022

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Since 2016, Epstein Becker Green (EBG) has researched, compiled, and analyzed state-specific content relating to the regulatory requirements for professional mental/behavioral health practitioners and stakeholders seeking to...more

McDermott Will & Emery

OIG Medicare Telehealth Data Brief Demonstrates Continued Focus on Data Analytics in Program Integrity Efforts

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On September 2, 2022, the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a data brief analyzing telehealth services covered by Medicare and related program integrity risks. OIG...more

ArentFox Schiff

OIG Reports Indicate the Government's Interest in Balancing Ongoing Telehealth Access With Increased Oversight

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A pair of reports recently issued by the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) highlight the important role telehealth services have played in ensuring access to medical...more

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