News & Analysis as of

Health Care: As Sunshine Act Deadlines Approach Physicians and Hospitals Should Prepare for Transparency in Their Financial...

On September 30, 2014, in accordance with the Federal Sunshine Act (the Sunshine Act), the Centers for Medicare and Medicaid Services (CMS) will publically disclose payments and "other transfers of value" by pharmaceutical,...more

You Are Now on the Clock — Sunshine Act Dispute Window Now Open

Beginning Monday, July 14, 2014, the review, dispute and correction process outlined the National Physician Payment Transparency Program (also known as the "Sunshine Act") opens on CMS's Open Payments website. Physicians and...more

CMS Releases Proposed 2015 Physician Fee Schedule and Pojects 20.9% SGR Reduction

CMS has issued the Proposed 2015 Physician Fee Schedule and Fact Sheets for specific issues (ASC, ESRD, Home Health, Physician Quality Programs)....more

OIG Report Recommends Increased Scrutiny of Over 1000 Laboratories With Questionable Billing for Medicare Part B Clinical...

According to a recently released report by the HHS Office of Inspector General (OIG), over 1,000 labs had unusually high billing for Medicare Part B Clinical Laboratory Services for dates of service in 2010. Increased...more

CMS Releases New Resources, Schedules Teleconference for Sunshine Review and Dispute Process

As we informed you last week, the Open Payments review, dispute and correction process started today and will continue through September 11, 2014. This is the process that allows physicians and teaching hospitals to review...more

CMS Proposes Relief for HH Face-to-Face and Therapy Reassessment Requirements

In the last issue, we reported on the difficulties faced by home health agencies (HHAs) in complying with the documentation requirements for the face-to-face (F2F) encounter between a patient and a physician before or shortly...more

CMS Proposes Changes to Sunshine Act Reporting

Drug and device manufacturers breathing a sigh of relief after completing their 2013 data submissions under the Physician Payment Sunshine Act (the “Sunshine Act’) must now contend with four proposed changes to the Sunshine...more

Cloudy Skies Ahead for Providers? CMS’ Release of Medicare Billing Data Combined with Physician Payment Sunshine Act Data May...

In February 2013, we reported (on our Healthcare Law Blog) that the Centers for Medicare and Medicaid Services (CMS) announced the final rule for the Physician Payments Sunshine Act. In the interest of providing more...more

AMA To Recommend Physicians Be Paid For End-Of-Life Planning

Brace yourself for a reprise of the death panel debate of 2009. The AMA will soon formally recommend to CMS that physicians be paid—or “reimbursed” in health care-speak—for talking with Medicare patients and their families...more

Quantifying and addressing improper payments for Medicare evaluation and management services

A review of Medicare Part B claims for evaluation and management (E/M) services conducted by the Office of the Inspector General (OIG) has found that the program paid $6.7 billion in improper payments in 2010. This figure...more

Health Care Update

In This Issue: - Transparency Latest Weapon against Rising Health Care Costs - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives -...more

CMS Requests Comments on the Dispute Resolution Process Associated with the Physician Payment Sunshine Act

On May 5, 2014, the Centers for Medicare & Medicaid Services ("CMS") announced an opportunity to submit comments on the dispute resolution and correction procedures proposed in the final rule on the Open Payments reporting...more

Recent OIG Report Underscores Need for Home Health Agencies and Physicians to Comply With Medicare’s Face-to-Face Documentation...

Medicare overpaid the home health industry $2 billion between January 2011 and December 2012, according to a recent report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG). The OIG’s...more

CMS Releases Open Payments Registration Information For Physicians And Teaching Hospitals; Phase 2 Timeline For Manufacturers And...

The Centers for Medicare & Medicaid Services (CMS) released today information regarding registration in the Open Payments system for physicians and teaching hospitals interested in reviewing and verifying data reported by...more

An Analysis Of Physician Compare Website

The rise of consumer-driven health care passed a milestone on Feb. 21, when, for the first time, the Centers for Medicare and Medicaid Services, or CMS, posted on its Physician Compare website performance scores on quality...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

Health Care E-Note - March 26, 2014

In This Issue: - Hospital CEO Turnover Rate Reached Record 20 Percent in 2013 - States Take on Authority of Doctors vs. Advanced Practice Nurses - HHS Urges Hospitals to be More Prepared for Emergencies -...more

When It Comes to Medicare Payment, Physicians Have Choices

Health care providers can choose to enroll in, participate in, or opt out of Medicare, but… - Not everyone can choose equally and their choices will net direct outcomes in their practice income. Medicare jargon can be...more

CMS authorizes contractors to deny ‘related’ claims of physicians who are not undergoing review

The Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services recently issued Transmittal 505 modifying Section 3.2.3 of the Medicare Program Integrity Manual. CMS employs a variety of...more

The Physician Payment Sunshine Act – The Top Five Steps for Physicians: The law defines “payment” to include almost any imaginable...

The Physician Payment Sunshine Act is a minor part of the Affordable Care Act, but it could result in major headaches for physicians. The chief purpose of the Sunshine Act is to make any payments made by medical manufacturers...more

Also in the News

President Obama Signs Pathway for SGR Reform Act of 2013 – On December 26, 2013, President Obama signed the Pathway for SGR Reform Act of 2013 (the “Act”), preventing the scheduled payment reduction for...more

SGR-Driven Payment Reduction Postponed Again

As part of the Balanced Budget Act of 1997 (BBA), Congress enacted a number of payment reforms designed to curb the growth of expenditures under Medicare Part B. One of the more notable of those provisions was the Sustainable...more

Final EHR Donation Rules Issued in Time for the New Year

On December 27, 2013, the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) issued final rules revising the Stark exception (42 CFR...more

Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For “Incident To” Services Means For Medicare Providers.

In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies...more

CMS Releases Final Rule for 2014 Medicare Physician Fee Schedule

CMS has released its much-anticipated final rule with comment for the Calendar Year (CY) 2014 Medicare Physician Fee Schedule (PFS). The final rule prescribes physician payment rates that will go into effect on January 1,...more

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