News & Analysis as of

Health Care Providers Centers for Medicare & Medicaid Services Medicare

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The Trump Administration has formally withdrawn a number of pending Department of Health and Human Services (HHS) proposals that never reached the final rule stage.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 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

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

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

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

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

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

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

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

What Exactly Is a Hospital, Anyway? CMS Issues Guidance on “Primarily Engaged” Medicare Certification Requirement

The rules that govern participation in the Medicare program are notoriously voluminous and complex. Indeed, courts have described them as akin to a “[body of] law written by James Joyce and edited by E.E. Cummings” and “among...more

When Is a Hospital Not a Hospital? New Guidance Sheds (Some) Light on the Definition

by McDermott Will & Emery on

The Centers for Medicare and Medicaid Services released guidance on September 6, 2017, intended to clarify the definition of “hospital.” The guidance provides factors that may be considered to determine whether a hospital is...more

New CMS Guidance on Inpatient Engagement Necessary for Hospital Certification

by McGuireWoods LLP on

On Sept. 6, 2017, the Centers for Medicare and Medicaid Services (CMS) issued an advanced copy of guidance to state survey agency directors that is intended to clarify how to determine whether a hospital seeking Medicare...more

Inspector General Audit Could Impact Skilled Nursing Facilities

by Ruder Ware on

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and...more

CMS Issues Guidance to Change Medical Reviewer Requirements for Complex Medical Reviews

Effective September 12, 2017, the Centers for Medicare & Medicaid Services (CMS) will implement changes to ensure that complex reviews for coverage determinations are performed by Registered Nurses (RNs), therapists, or...more

Healthcare Law Update: September 2017

by Holland & Knight LLP on

OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

HHS Seeks to Ease Burden of Hurricane on Health Care Organizations

by Baker Ober Health Law on

As Hurricane Harvey continues to have a devastating impact throughout Southeast Texas, Louisiana and the Southeast, our thoughts are with the hundreds of thousands struggling through this difficult time....more

OIG Issues Stark Warning to Skilled Nursing Facilities: Potential Abuse or Neglect of Residents Receiving Emergency Room Services...

On August 24, 2017, the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued an “Early Alert” that disclosed the preliminary results of its ongoing review of abuse of Medicare...more

Final Medicare Payment Regulations Expected for Physician Providers, Hospitals and Home Health Agencies in Fall 2017

by Baker Donelson on

The Centers for Medicare & Medicaid Services (CMS) released several annual Medicare proposed payment rules over the summer that are expected to be finalized this fall for 2018. On July 13, CMS released the proposed 2018...more

CMS Proposes Reimbursement Cuts for Certain Hospital Provider-Based Departments

by McGuireWoods LLP on

Non-excepted hospital off-campus provider-based departments (PBDs) may once again face cuts to reimbursement during calendar year 2018 (CY 2018) if the Centers for Medicare & Medicaid Services (CMS) finalizes proposed changes...more

Medicare Payments for Telehealth Increased 28% in 2016: What You Should Know

by Foley & Lardner LLP on

Telehealth providers can celebrate another successful year of growth, as CMS reported a 28% increase over total 2016 payments for telehealth services under the Medicare program. Providers continue to successfully integrate...more

Hospitals and Others Respond to “Red Tape Relief Project” Requests

Last week, a number of health care industry associations sent letters to Congress detailing ways in which the government could relieve them of the burdens associated with “red tape.” The letters are in response to the first...more

In Removing HSD Tables From Applications, CMS Opens the Door to Medicare Advantage Growth

by Faegre Baker Daniels on

Recently, the Centers for Medicare & Medicaid Services (CMS) released its draft 2019 Medicare Advantage application. Health plans seeking to participate in the Medicare Advantage (MA) program for the first time or expanding...more

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