News & Analysis as of

Health Care Providers Centers for Medicare & Medicaid Services

CMS continues to tinker with new physician Quality Payment Program created by MACRA

by Dorsey & Whitney LLP on

The Centers for Medicare & Medicaid Services (CMS) released an advanced copy of its latest proposed rule revising the Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The...more

"Meaningfully Useful" Risk Mitigation Strategies for Providers Following the eClinicalWorks Settlement

by Jones Day on

The Health Information Technology for Economic and Clinical Health Act ("HITECH Act") established financial incentives under Medicare and Medicaid for eligible health care providers that adopt, implement, and demonstrate use...more

Are you subject to MIPS reporting requirements in 2017?

by Thompson Coburn LLP on

The Centers for Medicare and Medicaid Services (“CMS”) announced in late April that they anticipated notifying eligible clinicians about their Merit-based Incentive Payment System (“MIPS”) participation status for 2017 via...more

CMS Proposes Delaying Implementation of New Home Health Agency CoPs

by Arnall Golden Gregory LLP on

On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) published a final rule revising the conditions of participation (CoPs) for home health agencies to participate in and qualify for the Medicare and...more

CMS Expects Almost All Eligible Clinicians in Advanced APMs to Meet Qualifying APM Participant Status for 2017

by Reed Smith on

CMS expects nearly 100% of eligible clinicians in Advanced Alternative Payment Models (APMs) to meet the Medicare Qualifying APM Participant (QP) standard for performance year 2017 and be eligible to receive a 5% APM...more

Reducing the risk of False Claims Act qui tam actions

by Shipman & Goodwin LLP on

Under the Federal False Claims Act (FCA), the presentation of a false claim for payment to the federal government can result in significant liability for providers participating in government-payer programs such as Medicare...more

Senate reintroduces resident rotator legislation, other GME-related Washington updates

by Dentons on

With the recent change of administration and a new congressional session beginning in 2017, medical education stakeholders have been watching closely for any signs on the political horizon regarding federal GME funding. Below...more

Proceed with Caution in Using New Process to Self-Report Stark Law Violations

by Barley Snyder on

Effective June 1, health care providers must use standardized forms for reporting Stark Law violations to the Centers for Medicare & Medicaid Services (CMS). These forms are part of a self-referral disclosure protocol (SRDP)...more

CMS Reverses Course on Arbitration Agreements

On October 4, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule prohibiting nursing homes from offering pre-dispute arbitration agreements to prospective residents upon admission. Now, CMS has...more

Preventing Overpayments from becoming False Claims

by Dickinson Wright on

Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s...more

Anchors Away! Physical Therapists Rejoice (and Book a Tropical Getaway) as CMS Extends Locum Tenens Arrangements

Even doctors get sick sometimes, or need to take a vacation, and when they do, patients are not seen and billing does not happen. Cue locum tenens – a system used by providers to ensure continuity of care and revenue when...more

An Unsettling Settlement: Health Plan to Pay $32 Million to Settle Coding and Provider Network Misrepresentation Charge

by Faegre Baker Daniels on

On May 30, the Department of Justice (DOJ) announced that it reached a settlement with commonly-owned Freedom Health Inc. and Optimum Healthcare, Inc. (Freedom Health) — two Tampa, Florida, managed care plans — to settle...more

CMS changes the SRDP process effective June 1, 2017

by Thompson Coburn LLP on

If you are in the process of drafting a SRDP submission, you must use the new SRDP forms or risk CMS not accepting the disclosure into the protocol. Effective June 1, 2017, the Centers for Medicare and Medicaid Services’...more

Reminder: New Voluntary Self-Referral Disclosure Effective June 1

by Ruder Ware on

As discussed in a previous blog, beginning on June 1, 2017, health care providers of services and suppliers wanting to voluntarily disclose actual or potential violations of the Stark Law must follow a new process finalized...more

Capitol Hill Healthcare Update

by BakerHostetler on

Congress’s official budget scorekeepers this week will release analysis of the House-approved bill repealing most of the Affordable Care Act (ACA), and that data will inform Senate Republicans on a path for passing their...more

Deemed Providers Beware: IPPS Rule Proposes Publicizing Accreditation Survey Results

by Baker Ober Health Law on

The veil of secrecy may soon be lifted from the reports of accreditation organizations like The Joint Commission if a proposal in the April 28, 2017 Inpatient Prospective Payment System (IPPS) Proposed Rule is finalized. As...more

Revocation of Enrollment in the Medicare Program- A Powerful Weapon in Medicare’s Arsenal

by Burr & Forman on

In 2014, CMS issued a final rule related to 42 CFR 424.535, which gave CMS expanded authority to impose penalties on providers. Although the rule is several years old, the first version published in 2006, the rule has been...more

GAO: CMS, MACs Should Bolster Provider Education to Cut Improper Medicare Payments

by Reed Smith on

In 2016, an estimated $41.1 billion in improper Medicare fee-for-services payments were made to providers. The Centers for Medicare & Medicaid Services (CMS) believes that provider education plays an important role in...more

Health Care Provider Insights - Introductory Edition

by Wilson Elser on

Welcome to the introductory edition of Health Care Provider Insights. We are practice management consultants, providing legal and business management advice and assistance to physicians and dentists (health care...more

Center For Medicare And Medicaid Services Proposes Delay Of Implementation Of New Home Health Agency Rules

by Roetzel & Andress on

On January 13, 2017, the Center for Medicare and Medicaid Services (CMS) issued a final rule relating to a series of changes for conditions to participation in Medicare and Medicaid by home health agencies (HHAs). At the time...more

Ten Things Investors Need to Know About Value-Based Healthcare

by Ropes & Gray LLP on

This article highlights key business and legal issues related to value-based healthcare for investors considering opportunities in the healthcare industry. 1. Value-Based Arrangements Are Here to Stay Value-based...more

The Financial Impact of MACRA – Uncertainty Reigns in a Recent Rand Corporation Study

With all the talk of the Affordable Care Act’s uncertain future, it is easy to forget about the Medicare Access and CHIP Reauthorization Act (“MACRA”), a bipartisan law passed by Congress in 2015 to change the way physicians...more

Stark Law: What Providers Should Know About New CMS Form

by Polsinelli on

The Centers for Medicare and Medicaid Services (CMS) has finalized Form CMS-10328 (the SRDP Form), a new OMB-approved information collection instrument that must be used by providers and suppliers utilizing the Stark Law...more

CMS Proposes FY 2018 Update to Medicare Hospice Payment Rules; Solicits Ideas for Hospice Program Improvements

by Reed Smith on

CMS has published a proposed rule to establish fiscal year (FY) 2018 Medicare hospice reimbursement rates, update hospice quality programs, and request public input on ways to improve the Medicare hospice program. The...more

CMS Issues New SRDP Forms

by Dorsey & Whitney LLP on

The Centers for Medicare and Medicaid Services (“CMS”) issued new Self-Referral Disclosure Protocol (“SRDP”) forms, and, beginning June 1, 2017, these SRDP forms will be mandatory for those parties submitting voluntary...more

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