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CMS Issues Medicare Advantage And Part D Final Call Letter For 2015

The Medicare Advantage and Part D Final Call Letter announces requirements for the 2015 contract year, including changes to Part C and Part D star ratings and how CMS will evaluate Part D plan structures submitted for the...more

CMS Releases Rate Announcement and Final Call Letter for Medicare Advantage and Part D Programs

On April 7, 2014, CMS issued the 2015 rate announcement and final call letter for the Medicare Advantage and Part D programs. Notably, CMS reversed planned rate cuts to Medicare Advantage plans, and is instead replacing those...more

Don't Be Left On The Sidelines: CMS Is Seeking Applications For A New Hospice Demonstration Program

Currently, Medicare patients that wish to receive palliative hospice care have a tough choice to make—forgo any curative treatment or incur all hospice care costs. This could change, however, with the recent launch of CMS's...more

CMS Releases 2012 Physician Medicare Data: Five Takeaways

On April 9, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (the “Data File”). The Data File contains...more

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

Also in the News

CMS to Provide Public Access to Physician Payment Data – In a recent post on its official blog, CMS announced it will provide “unprecedented access” to information on services delivered by individual physicians and certain...more

CMS Releases Medicare Part B Supplier Billing and Payment Data

Potential for Increase in Whistleblower Litigation - On April 8, 2014, The Centers for Medicare & Medicaid Services (CMS) released, with tremendous fanfare, hundreds of thousands of points of billing data regarding...more

CMS Releases Physician Medicare Billing Data

The U.S. Department of Health and Human Services (HHS) announced on April 9th a “historic” release of Medicare payment data to provide consumers with “unprecedented transparency on the medical services physicians provide and...more

Department of Health and Human Services to Release Medicare System Data

Last week, the Department of Health and Human Services (HHS) announced that they will begin to publicly release Medicare system data, including payment and utilization rates, for the 880,000 physicians currently participating...more

CMS Issues Final Call Letter for 2015

Earlier this week, CMS announced in its Final Call Letter that Medicare Advantage rates would rise an average of 0.4 percent in 2015, instead of falling 1.9 percent as proposed in February. CMS’s shift in course may stem...more

I’ll Be Watching You: Medicare Billing Info on over 880,000 Providers Released by CMS to Improve Transparency

Every payment you take, every claim you make, someone will be watching you. No, we don’t mean Sting. We mean all the consumers and businesses that will have greater access to physician billing information now because today...more

ACA’s Deductible Limits for Small Groups Repealed

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. The primary purpose of the law is to provide a one-year delay of a 24% reduction in payment rates for physicians who participate...more

Number 17: Congress Patches the SGR Yet Again

For the 17th time since the Sustainable Growth Rate (SGR) became law as part of the Balanced Budget Act of 1997, last week the Congress passed a short-term “patch” to prevent scheduled cuts from going into effect for...more

Do you understand the new Medicare surtax?

Here are six simple rules for individual taxpayers to remember - Beginning with tax year 2013, certain individuals, trusts, and estates may be subject to a 3.8% surtax under Section 1411 of the Internal Revenue Code....more

Also in the News

MACs to Hold Claims for MPFS Services for Ten Business Days Beginning April 1, 2014 – According to Medicare Learning Network Connects eNews, pending the outcome of the SGR Doc Fix legislation (discussed in more detail in...more

Medicare OPPS Lab "Packaging" Policy Raises Bundle of Issues

In previous Payment Matters articles, we described a policy included in the 2014 hospital outpatient prospective payment system (OPPS) final rule that would “package” certain clinical laboratory tests into OPPS, and CMS...more

CMS Advised to Follow Private Sector Practices to Improve Physician Feedback Reports

On March 26, 2014, the Government Accountability Office (GAO) released its report regarding the private sector’s physician feedback reporting practices and how implementation of such practices could improve CMS’s own reports...more

CMS to Test New Models of Care for Hospice: Summary of the Medicare Care Choices Model

On March 18, 2014, CMS launched an initiative to “develop innovate payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid.”...more

CMS Releases Fiscal Year 2012 Recovery Auditing Report

In a recent report on the Recovery Audit program for fiscal year (FY) 2012, CMS reports that Recovery Auditors identified $2.4 billion dollars in improper payments, including $2.3 billion in overpayments and $109.4 million in...more

Chance to Comment on Future of DMEPOS Payments

CMS recently took the unusual step of issuing an Advance Notice of Proposed Rulemaking (ANPR) regarding changes to Medicare payment methodologies for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)...more

Health Care Update

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Upcoming Hearings and Markups. Excerpt from...more

MedPAC Releases Annual Report on Medicare Payments

The Medicare Payment Advisory Commission (MedPAC) recently submitted its annual report on Medicare payments to Congress. The report analyzes Medicare payment policy and makes payment update recommendations relating to...more

Health Law Insights Newsletter

The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for compliance with the two-midnight rule through September 30, 2014. The rule provides that if an inpatient stay crosses two midnights, the...more

CMS Extends Deadline for Low-Volume Hospitals and the Medicare-Dependent Hospital Program

On March 14, 2014, CMS released an interim final rule implementing a six-month extension of the low-volume payment adjustment and Medicare-Dependent Hospital (MDH) program under the inpatient prospective payment system (IPPS)...more

CMS Will Not Move Forward With Four Controversial Provisions in Recent Part D Proposed Rule

On March 10, 2014, CMS Administrator, Marilyn Tavenner, sent a letter to Rep. Sander Levin (D-Mich), the Ranking Member of the House Ways and Means Committee, stating that CMS has decided not to finalize four controversial...more

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