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Health Headlines: Also in the News - July 2014

New ACO Rules Sent to OMB for Review – On June 26, 2014, a proposed Accountable Care Organization (ACO) rule that would make changes to the Medicare Shared Savings Program in advance of the second round of ACO contracts...more

OIG Report: Questionable Billing for Medicare Part B Clinical Laboratory Services

Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG –...more

Medicare's Proposed Home Health Rule for 2015: CMS Suggests Only Limited Relief to the Face-to-Face Encounter Documentation...

On July 7, 2014, the Centers for Medicare & Medicaid Services ("CMS") published proposed changes to the Medicare Home Health Prospective Payment System ("HH PPS") for calendar year 2015 ("Proposed Rule"). The Proposed Rule...more

CMS Wants To Shine Light On CME Payments To Physicians

It’s a question CMS has been wrestling with since the enactment of the Sunshine Act (sometimes called the Open Payments Program) as part of the Affordable Care Act. The Sunshine Act generally requires a manufacturer to...more

CMS Proposes Elimination of CME Exception to Sunshine Act Reporting

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule that includes a plan to eliminate the continuing medical education (“CME”) exclusion to the reporting requirements under the federal Physician...more

CMS Releases CY 2015 ESRD PPS and DMEPOS Proposed Rule

On July 2, 2014, CMS released the CY 2015 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Proposed Rule. ...more

CMS Releases Proposed HHA Rates for 2015 and Other Proposed Changes Affecting HHAs

On July 1, 2014, CMS released the proposed update to the Home Health Prospective Payment System (HH PPS) rates, which would apply to calendar year 2015 Medicare payments. ...more

Health Care Update - July 2014

In This Issue: - E&C continues to push for bipartisan efforts to improve drug pipeline - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Health Care...more

Personalized Medicine Today: PMC Issues Fourth State of the Industry Report

Personalized medicine is changing the paradigm of the research, development and delivery of health care. The Personalized Medicine Coalition (PMC), a consortium of interested stakeholders that seeks to promote the...more

CMS seeks to update payment rates and eligibility certification requirements in proposed rule for Medicare home health services

On July 7, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule updating Medicare’s Home Health Prospective Payment System payment rates for 2015....more

Healthcare Legal News - July 2014 • Volume 4, Number 2

In This Issue: - DO SUBSIDIZED HEALTH CARE PLANS PURCHASED UNDER THE AFFORDABLE CARE ACT TRIGGER THE ANTI-KICKBACK STATUTE? The advent of federally subsidized private pay health insurance under the Affordable...more

Insider Trading Gets Political: Trading on Political Intelligence

Some things are better left unsaid. Especially, it seems, when they involve political intelligence shared by a congressional aide with a lobbyist linked to a political intelligence firm serving Wall Street traders....more

Health Care Update - June 2014 #4

In This Issue: - Hobby Lobby decision further complicates ACA implementation - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State...more

Newly Released CMS Actuary’s Report Confirms CMS Ignored Impact of Two Midnight Rule on Medical Admissions When Setting 0.2...

On June 30, 2014, King & Spalding filed comments in response to Medicare’s proposed IPPS rule for Fiscal Year (FY) 2015 on behalf of more than 200 hospitals it represents in a federal court challenge to the FY 2014 Two...more

The Intractable Problem of Medicare Fraud

You have to admire the vigilance and dedication of prosecutors and law enforcement investigators who fight Medicare fraud. There is no question that they have ramped up enforcement and promoted a strong message of deterrence....more

Health Care Reform Implementation Update - June 2014

Secretary Burwell continues to settle in to her new position as the Department of Health and Human Services (HHS), this week making a number of management changes at the department; CMS released the long awaited proposed rule...more

Health Headlines: Also in the News - June 2014 #3

MedPAC Recommends Short- and Long-Term ACO Changes – In a comment letter sent to CMS Administrator Marilyn Tavenner on June 16, 2014, the Medicare Payment Advisory Commission (MedPAC) outlined certain challenges associated...more

Finishing at the Top of the Class: The Risks Faced by High Achievers on the Medicare Billings List

In this increasingly competitive world, providers generally want to be at the top of almost any official ranking. CMS’s recently released list of medical groups and physicians receiving the most Medicare reimbursement dollars...more

#HealthyPA Takes the Next Step

The governor’s recent announcement that 9 commercial insurers successfully applied to participate in Healthy PA is another positive development as negotiations between Department of Public Welfare and the Centers for Medicare...more

GAO Concludes States Should Strengthen Medicaid Managed Care Program Integrity Efforts

The Government Accountability Office (GAO) recently released a report examining why Medicaid managed care programs made an estimated $14.4 billion in improper payments for fiscal year 2013. GAO found that the improper...more

Health Care Update - June 2014 #3

In This Update: - CMS Getting New Leadership Roles - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other...more

Health Update - Jun 2014

Removing Regulatory Barriers to Accelerate EHR Adoption - Recognizing the potential long-term value of EHRs for improving care and reducing costs, many hospitals considered offering physicians financial support to...more

Coming Soon To A Hospital Near You: The Five-Star Rating System

You choose your movies, restaurants and hotels based on a five-star system: one star for the worst, five for the best. Why not choose your hospital the same way? That seems to be the reasoning behind yesterday’s...more

The New "Meaningful Use" Landscape: A Transition from Incentives to Penalties - CMS Begins Enforcing Penalties for Failure to...

Starting in 2015, eligible physicians and hospitals participating in the Medicare Electronic Health Records Incentive Program who do not adopt "meaningful" use" certified electronic health record (EHR) technology will no...more

Insurance carrier ending coverage of physicians under Medicare Advantage contracts

Physicians, healthcare providers, insurers and other interested parties should be aware that a large insurance carrier operating Medicare Advantage plans in Missouri and Illinois recently has begun terminating its...more

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