The CMS Interoperability and Prior Authorization Rules
Podcast — Drug Pricing: How Are Payers Responding to the IRA?
Findings from Gibbins’ Annual Healthcare Bankruptcy Report
A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration
Video: Braidwood v. Becerra – Challenging the Affordable Care Act’s Preventive Services Coverage Provision – Thought Leaders in Health Law
Hospice and Home Health Survey Perspectives: A Conversation with Kim Skehan, VP of Accreditation at CHAP
Transparency and the Open Payments Program
Taking the Pulse, A Health Care and Life Sciences Video Podcast | Episode 173: Improving rural health care with Dr. Kevin Bennett, the Director of the Research Center for Transforming Health and the
Counsel That Cares - The Private Payer's Perspective on Value-Based Care
Podcast: Health Equity – Behind the Buzzwords – Diagnosing Health Care
A Very “Special” Episode: Amid Controversy, CMS Launches the Hospice Special Focus Program
Grace from CMS: Unexpected Good News on HIS and CAHPS Appeals
This Bandwagon Has a Broken Wheel: OIG Joins the Inconsistent Approach to Hospice GIP Claims
Behind the Curtain: Enhanced Provider Enrollment Oversight
Survey Woes: CMS Ramps Up Hospice Survey Program and Consequences
Inflation Reduction Act’s Drug Price Negotiation Provisions – What Now? – Diagnosing Health Care Podcast
A Glimpse Into the Other Side: Understanding the Perspective of Government Enforcers
I Understood There Would Be No Math: Audits, Extrapolations, and a New Set of Rules
Podcast: Inflation Reduction Act’s Drug Price Negotiation Provisions – What’s Next? - Diagnosing Health Care
Quick Takeaways From the 2024 Proposed Hospice Wage Index Rule
The 60-day Refund Rule, created by the 2010 Affordable Care Act, requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. See Section 1128J(d) of the Social Security Act,...more
A key element of the Medicaid Redesign Team 1115 Waiver amendment is the Medicaid Hospital Global Budget Initiative (GBI), a reimbursement model tied very closely to the States Advancing All-Payer Health Equity Approaches and...more
If you have been following the implementation of the No Surprises Act independent dispute resolution (IDR) process, you have likely seen a bunch of new rules, guidance documents and deadline extensions come out recently and...more
Employers, this is your annual reminder that the Centers for Medicare & Medicaid Services (CMS) requires sponsors of group health plans to notify eligible individuals whether the employer’s prescription drug coverage is...more
Sunshine Act reporting for Program Year 2022 (January 1, 2022 – December 31, 2022) must be submitted to CMS via the Open Payments System by March 31, 2023. What is the Sunshine Act? - The Physician Payments Sunshine...more
On May 17, the U.S. District Court for the District of Columbia issued a decision vacating the Accumulator Adjustment Rule, regulations issued by the Centers for Medicare and Medicaid Services (CMS) in December 2020 as part...more
Following the Supreme Court’s decision in Biden v. Missouri, CMS will require those states previously subject to federal district court injunctions to be compliant with the “Phase 1” requirements of its Interim Final Rule...more
Since we first explained the CMS vaccine mandate (the Interim Final Rule (IFR) from the Centers from Medicare & Medicaid Services (CMS) that requires COVID-19 vaccinations for all staff at covered facilities), the mandate has...more
In December 2021, the US Centers for Medicare and Medicaid Services (CMS) issued the second part of its FY 2022 Inpatient Prospective Payment System (IPPS) Final Rule with Comment Period. Among other policies, the Final Rule...more
On December 28, 2021, the Centers for Medicare and Medicaid Services (CMS) Quality, Safety and Oversight Group released a memorandum (QSO-22-07-ALL) providing guidance and details on survey procedures for assessing and...more
The Centers for Medicare & Medicaid Services (CMS) announced it will enforce the COVID-19 Health Care Staff Vaccination Interim Final Rule in the 25 states, District of Columbia, and territories in which the healthcare...more
Developments immediately before the holiday break have many employers scrambling as the OSHA ETS has seemingly come back to life. The Sixth Circuit, in a 2-1 decision by a 3-member panel, dissolved the temporary stay...more
The Biden administration on Nov. 4 released a Fact Sheet announcing the details of its Occupational Safety and Health Administration (OSHA) and Center for Medicare and Medicaid Services (CMS) COVID-19 vaccination mandates. ...more
The White House released a Fact Sheet on November 4, 2021, aimed at covered federal contractors announcing they now have until January 4, 2022 for their covered employees to obtain their final vaccination dose. Under...more
The Biden administration has modified a September executive order (EO) to extend the vaccine mandate compliance deadline for federal contractors to January 4, 2022. In a statement, the White House said the change was...more
On November 4, 2021, the White House released a fact sheet on the issuance of new OSHA ETS and CMS Rules and also addressed some changes to the previously announced EO 14042 federal contractor vaccination mandate. During last...more
On November 4, 2021, the US Occupational Safety and Health Administration (OSHA) unveiled its Emergency Temporary Standard (ETS) to protect employees of large employers in all industries from COVID-19. The Centers for...more
Group health plan sponsors are required to send annual notices (as well as at other particular times) to individuals who are eligible for Medicare Part D that explain whether the health plan’s prescription drug coverage is...more
Under section 1135(b)(5) waiver authority, CMS once again extended the submission deadline for both new Medicare graduate medical education (GME) affiliation agreements and amendments to existing Medicare GME affiliation...more
On October 8, the Centers for Medicare & Medicaid Services (CMS) released new details on repayment terms for the Medicare Accelerated and Advance Payments Program, a loan program that sent aid to Medicare Part A providers and...more
The Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) has followed the guidance, jointly issued by the U.S. Departments of Labor and the Treasury, that extends benefits-related deadlines...more
On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers to the Stark Law that permit certain arrangements between physicians and health care providers implemented in response to COVID-19...more
Eligible hospitals and Critical Access Hospitals (CAHs) must demonstrate meaningful use of certified electronic health record technology (CEHRT) to avoid negative Medicare payment adjustments under the Promoting...more
The Centers for Medicare & Medicaid Services (CMS) recently extended the meaningful use attestation deadline for the Electronic Health Record (EHR) Incentive Program from February 28, 2018, to March 16, 2018....more
For the second time in less than one year, CMS has updated its instructions for completing Worksheet S-10 of the Medicare cost report for hospitals. The new instructions expand the definition of charity care, as reported in...more