News & Analysis as of

Health Care Providers Centers for Medicare & Medicaid Services

Will CMS Consider Your Institution to Be a Hospital? Guidance on the "Primarily Engaged In" Standard

by Baker Ober Health Law on

Recent guidance from CMS suggests that some hospitals, and particularly specialty hospitals that provide mostly outpatient care, may soon find themselves the focus of surveyors' scrutiny. In early September, CMS issued...more

Trump Administration Shelves Additional Obama Medicare/Health Plan Proposals

by Reed Smith on

The Trump Administration has formally withdrawn a number of pending Department of Health and Human Services (HHS) proposals that never reached the final rule stage. This includes: a controversial Part Medicare B drug payment...more

CMS Announces CY 2018 Amount in Controversy Thresholds for Medicare Appeals

by Reed Smith on

CMS has released the calendar year (CY) 2018 amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The CY 2018 AIC threshold amounts...more

CMS Releases 2018 Open Payments/Sunshine Act Reporting Thresholds

by Reed Smith on

CMS has announced inflation-adjusted de minimis reporting thresholds for 2018 under the Open Payments/Physician Payments Sunshine Act program. Specifically, payments or transfers of value of less than $10.49 do not need to...more

You-Can’t-Make-this-Up Award

by Faegre Baker Daniels on

From time to time a development in health law confirms the adage that truth is stranger than fiction. That’s why we hand out the You-Can’t-Make-this-Up Award for real life developments that seem to defy the imagination....more

CMS issues new guidance on interim rates for new teaching hospitals

by Dentons on

Prompted by confusion among Medicare Administrative Contractors (MACs) regarding how to initiate payments to new teaching hospitals, CMS issued on September 22, 2017, a One-Time Notification, Transmittal 1923, "Calculating...more

K&L Gates Triage: Emergency Preparedness and Response in Long Term Care

by K&L Gates LLP on

This is the first episode in a three-part series on emergency preparedness and response in long-term care. Recent hurricanes affecting the United States have brought to light the importance of health care providers devising a...more

Trump Administration Seeks Stakeholder Input on New Direction

by K&L Gates LLP on

On September 20, 2017, the Centers for Medicare and Medicaid Services (“CMS”) released an informal request for information (“RFI”) seeking stakeholder feedback on the future direction of the Center for Medicare and Medicaid...more

Blog: CMS Withdraws Part B Demo Rule…for good

by Cooley LLP on

Earlier today, the Centers for Medicaid Services (CMS) released a notice withdrawing the “Medicare Program; Part B Drug Payment Model”, also known as the “Part B Demo.” As we discussed in a previous post, in December 2016,...more

Business Viewpoint with Philip Hixon: New rules and costs for long-term care

by GableGotwals on

Ronald Reagan once declared, “The nine most terrifying words in the English language are: ‘I’m from the government, and I’m here to help.’” Long-term care facilities experience this “help” with increasing frequency....more

CMS Expanding The "Targeted Probe And Educate" Audits Nationally This Fall

by Roetzel & Andress on

The Centers for Medicare and Medicaid Services (“CMS”) announced recently that it will be expanding its medical claims review program to cover the entire country by the end of this year. The expanded program, titled “Targeted...more

CMS Extends Reporting Exceptions to Providers Impacted by Hurricane Irma

by Arnall Golden Gregory LLP on

On September 18, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum updating the Medicare quality reporting and value-based purchasing programs exceptions CMS is extending to certain healthcare...more

OIG Work Plan – September 2017 Update

by Baker Ober Health Law on

Beginning in June 2017, the OIG began making monthly Work Plan updates. These monthly updates create some practical challenges for health care providers and compliance professionals trying to make operational and compliance...more

OIG Issues “Early Alert” on Potential Cases of SNF Abuse/Neglect

by Reed Smith on

The Office of Inspector General has issued an “early alert” warning that “CMS procedures are not adequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in [skilled nursing...more

CMS Calls for “New Direction” for Innovation Center, Invites Ideas for New Payment Models

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) CMS has announced a “new direction” for the CMS Innovation Center that is intended to “promote patient-centered care and test market-driven reforms.” The goal of these...more

CMS Corrects Sunshine Act CMP Regulations due to Inflation Adjustment Error

by Reed Smith on

CMS has just corrected an error in a 2016 rulemaking that inadvertently called for a 10-fold increase in certain “Sunshine Act” civil monetary penalties (CMPs). Under section 1128G of the Social Security Act, applicable...more

CMS Call: IMPACT Act and Improving Care Coordination (Sept. 28)

by Reed Smith on

CMS is hosting an Open Door Forum conference call September 28, 2017 to provide information and solicit feedback on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Among other things, the call...more

Hospital Medicare Certification at Risk? CMS Clarifies Inpatient Volume Expectations

by Polsinelli on

Hospitals with dangerously low inpatient volume and micro hospitals focused primarily on the delivery of outpatient and/or emergency room services instead of inpatient services beware: CMS (Centers for Medicare and Medicaid...more

Dealing with Disasters – Quality Payment Program Exception Available for MIPS-Participating Clinicians and Groups

by Polsinelli on

The Centers for Medicare & Medicaid Services (CMS) simplified the process for clinicians and other providers to seek the Quality Payment Program (QPP) Hardship exception by releasing an online application on Aug. 2....more

CMS Provides Waivers in States Affected by Hurricanes Harvey and Irma

by McGuireWoods LLP on

September 20, 2017 The Centers for Medicare & Medicaid Services (CMS) recently modified and waived certain Medicare enrollment and billing requirements to ensure the availability of adequate medical care for Medicare...more

A Category 5 Compliance Problem: Hurricane Irma Gives Providers a Stark Reminder of Emergency Preparedness Realities

by Carlton Fields on

The havoc that Hurricane Irma caused in the Caribbean and most of Florida reminds us of the Centers for Medicare and Medicaid Services (CMS) requirements for emergency preparedness, which take effect November 15....more

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

CMS To Expand Use of TPE Audits Nationwide by End of 2017

by Dorsey & Whitney LLP on

Perhaps lost amid the healthcare news coverage of competing proposals regarding “Medicare for All” and the repeal of Obamacare, the Centers for Medicare & Medicaid Services (“CMS”) last month announced the expansion of its...more

CMS Announces Revisions to State Operations Manual for Hospitals “Primarily Engaged” in Providing Care to Inpatients

by King & Spalding on

On September 6, 2017, CMS’s Center for Clinical Standards and Quality/Survey & Certification Group announced revisions to Appendix A of the State Operations Manual (SOM), which governs hospital surveys. The revisions are...more

Revoked: CMS's New Take on Record Retention and Access

Recently, we have noticed an alarming increase within the Spilman footprint of revocations by the Centers for Medicare & Medicaid Services ("CMS") of physicians' Medicare billing privileges. In particular, CMS has been...more

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