Centers for Medicare & Medicaid Services

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CMS Refuses to Count Family Practice Residents Who Train in Family Practice Settings

Last Friday Eastern Maine Medical Center sued Health & Human Services over the way CMS counted the number of residents in its graduate medical education program. According to the complaint, CMS refuses to count some of the...more

Health Care Update - September 2014 #4

In This Issue: - Policymakers Continue Bi-partisan Push to Accelerate ACO Evolution - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and...more

A Brave New World of Transparency Reporting: CMS Launches Open Payments Website

September 30th marked the launch of transparency reports under the Sunshine Act through a new Open Payments website hosted by the Centers for Medicare & Medicaid Services (CMS)....more

Blog: CMS Releases First Year Open Payments Data

The Centers for Medicare & Medicaid Services (CMS) promised the government, industry and the public that it would release the first round of data in connection with the Physician Payment Sunshine Act by September 30, 2014,...more

Federal District Court Vacates Decision of Medicare Appeals Council on Inpatient Rehabilitation Coverage

In its recent decision in Teche Specialty Hospital v. Sebelius, the District Court for the Western District of Louisiana vacated two inpatient rehabilitation (IRF) coverage denials by the Medicare Appeals Council (MAC). The...more

Health Law Pulse - September 2014

In This Issue: - U.S. Court of Appeals Holds that Physicians’ Employer is Personally Liable for Costs Associated with The H- 1B Process and Obtaining a Waiver of the Two- Year Home Residency Requirement - CMS...more

Risks of Over-Medicating Residents and Potential Liability Under the FCA

According to the Complaint, Country Villa Watsonville East Nursing Center (now Watsonville Nursing Center) and Country Villa Watsonville West Nursing and Rehabilitation Center (now Watsonville Post-Acute Center) “persistently...more

Health Reform + Related Health Policy News - September 2014, Issue 1

In This Issue: - Top News ..The Congressional Agenda is Light as the Focus Shifts to the Midyear Elections ..Physician Supervision Requirement for Small and Rural Hospitals ..CMS Offers Hospitals...more

CMS Charges $13 Million Late Payment Fee on $1 Million Medicaid Overpayment

To add insult to injury, the overpayments were inadvertent—the result of electronic coding errors on about 900 Medicaid claims. On top of that, Mt. Sinai itself didn’t make the errors. They were made by two hospitals in the...more

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

Congressman Sends Letter to Secretary of HHS Urging Her to Retract CMS’s Global Settlement Offer – On September 15, 2014, Congressman Kevin Brady (R-Tex), Chairman of the House Ways and Means Health Subcommittee, sent a...more

OIG Reports Medicare Part B Supplying and Dispensing Fees Significantly Higher Than Those Under Part D and Medicaid

According to a recently released report from the HHS OIG, pharmacies are reimbursed significantly more for dispensing drugs under Medicare Part B than they would be for dispensing the same drugs under Medicare Part D and...more

New Hospice Cost Report Released: Effective for Cost-Reporting Periods Beginning Next Week

On August 29, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released the final version of the new Medicare cost report, Form CMS 1984-14, applicable to freestanding hospice providers. Freestanding hospice...more

Overpayments to Skilled Nursing Facilities on the Rise

Nearly $2.5 billion dollars in overpayments were made to Skilled Nursing Facilities (“SNFs”) as a result of billing errors last year. The billing error rate for SNFs jumped to 7.7 percent, virtually doubling in 2013....more

CMS Issues Final Rule Providing Flexibility for Providers Unable to Fully Implement 2014 Technology to Demonstrate Meaningful Use...

In response to providers being unable to fully implement 2014 Edition certified electronic health record technology (CEHRT) due to limited availability, CMS adopted changes proposed earlier this year through a final rule...more

Is CMS Feeling the Sunshine Heat? – Part 3

As we discussed in Part 1 and Part 2 of this ongoing story, the Centers for Medicare & Medicaid Services (CMS) has received significant criticism related to issues with the Open Payments database and its plans to release the...more

CMS Releases MSSP and Pioneer ACO Data on Shared Savings and Losses – Where Do We Go From Here?

On September 16, 2014, the Centers for Medicare & Medicaid Services (CMS) announced key shared savings and losses results of Accountable Care Organizations (ACOs) that began participating in the Medicare Shared Savings...more

Court Dismisses AHA’s Challenge to CMS Billing Policy

On September 17, 2014, the U.S. District Court for the District of Columbia dismissed a lawsuit brought by the American Hospital Association (AHA), three individual hospitals, and two health care systems that challenged CMS’s...more

CMS Continues to Struggle with How to Provide High Quality Care to Dual Eligibles

Last week CMS announced that it would not execute its option to terminate its 2015 contracts with Medicare Advantage Plans and Part D plans that had scored three stars or less for three consecutive years. ...more

CMS Seeks Comments on Data Sharing Effort With Treasury Department

CMS issued a Notice of Computer Matching Program (Program) on September 8, 2014, requesting comments on a planned data matching partnership with the United States Department of Treasury. The Program authorizes the Treasury...more

Face-to-Face Medicare Reimbursement Requirements for Home Health Certification

CMS has announced its concern regarding the level of compliance for documenting the face-to-face elements necessary for home health care certification....more

Health Law Alert: CMS Modifications to Meaningful Use Rule Gives Providers a Welcome Reprieve

On September 4, the Centers for Medicare & Medicaid Services (CMS) published a Final Rule that made several helpful changes to the meaningful use requirements for the Electronic Health Record (EHR) Incentive Program. Among...more

CMS Clarifies Terms of Global Settlement Offer

As previously reported, on August 29, 2014, CMS issued a global settlement offer (GSO) to acute care hospitals with pending appeals of denials for inpatient claims. Specifically, CMS is offering to settle all qualifying...more

OIG Criticizes CMS’s 16-Year Delay in Issuing Regulations; CMS Yawns

Turns out it’s not just health care providers that notice CMS’s foot-dragging. Last Thursday the Office of Inspector General (OIG) of Health & Human Services (HHS) published its report on what CMS has done—or rather, has not...more

Final Meaningful Use Rule: CMS Loosens its Grip

The Centers for Medicare & Medicaid Services (“CMS”) finalized a rule on August 29th which should give providers some breathing room in complying with meaningful use requirements for the Electronic Health Record (“EHR”)...more

Health Care Reform Implementation Update September 2014

Congress is back in session, and work on a Continuing Resolution is underway. The Affordable Care Act (ACA) is back center stage with House Republicans attaching a medical device tax repeal provision to a jobs package set for...more

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