News & Analysis as of

Health Care Providers Centers for Medicare & Medicaid Services Medicare

CMS request for information presents rare opportunity for medicare stakeholder engagement

by Hogan Lovells on

On 14 April 2017, the Centers for Medicare & Medicaid Services (CMS) published the fiscal year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

Leasing to Health Care Tenants: What You Need to Know

by Pepper Hamilton LLP on

Commercial office building landlords frequently find themselves leasing to health care provider tenants. A landlord may not consider doctor’s offices or diagnostic labs as specialty uses, but there are several lease...more

Calling for Ideas—CMS Releases Final 2018 Medicare Advantage and Part D Rate Announcement and Call Letter

by Hogan Lovells on

On 3 April 2017, the Centers for Medicare & Medicaid Services (CMS) released its final Medicare Advantage (MA) and Part D Rate Announcement and Call Letter (Call Letter) for calendar year 2018. The Call Letter is part of...more

CMS Revises the Self-Referral Disclosure Protocol Requiring the Use of Prescribed Forms for Disclosure of Stark Law Violations

by McDermott Will & Emery on

The Centers for Medicare and Medicaid Services (CMS) recently posted revisions to the Voluntary Self-Referral Disclosure Protocol (SRDP). In an attempt to streamline the self-disclosure process, CMS requires the use of new...more

CMS Encourages Providers/Suppliers Not To Put Off Emergency Preparedness Training Exercises; Educational Call Scheduled for April...

by Reed Smith on

CMS is reminding Medicare- and Medicaid-participating providers and suppliers that they will be expected to comply with training and testing requirements included in a September 2016 emergency preparedness final rule by...more

CMS Delays Implementation of New Payment Models (Again)

On March 21, 2017, the Centers for Medicare and Medicaid Services (“CMS”) published an interim final rule (“Interim Final Rule”) delaying (i) the effective date of several new Medicare payment models developed by the CMS...more

Long-Term Care Facilities Subject to New Medicare Requirements for Participation Must Comply with Staffing, Training, and...

by Arnall Golden Gregory LLP on

On October 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule which represents the most sweeping changes in twenty-five years regarding the requirements for participation for long-term care (LTC)...more

Fifth Circuit Upholds CMS’s Critical Access Hospital Guidelines

by King & Spalding on

CMS’s definitions of “primary roads” and “secondary roads,” as used to determine what constitutes a critical access hospital, withstood another court challenge last week....more

Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

by Snell & Wilmer on

For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the...more

Shorts On Long Term Care March 2017 - News for the NC LTC Community

by Poyner Spruill LLP on

Thursdays with Mama - Life has a rhythm, a symmetry, a meter, a metric. It’s rarely smooth or perfect. It’s knots and knuckles, bumps and bruises. It’s rough and tumble. It sings its own song in its own...more

Recent Changes to Medicare “Incident To” Billing Rules

by Ruder Ware on

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more

Medicare Mandatory Bundled Payments Rule: Minor Aspects Delayed, Others On-Schedule for July Implementation

by Polsinelli on

In a move the Centers for Medicare & Medicaid Services cites as a reaction to President Donald Trump's regulatory freeze, CMS announced that implementation of certain minor aspects of the final rule expanding Medicare...more

New Medicare Conditional Payment Case: Federal Court Requires CMS To Perform Surgery On Its Primary Plan Reimbursement Demands

Doctors often treat Medicare beneficiaries for accident related injuries (for which a “primary” auto or workers’ compensation carrier must reimburse Medicare) and unrelated maladies at the same visit. Billing for the visit...more

Capitol Hill Healthcare Update

by BakerHostetler on

Meeting privately with Senate Republicans to discuss next steps on the ACA was among the first actions taken last week by the new Secretary of the U.S. Department of Health and Human Services Tom Price. But GOP senators left...more

Medicare & Medicaid Remain Vulnerable to Fraud and Abuse, GAO Warns

by Reed Smith on

The Government Accountability Office (GAO) is out with the latest installment of its “High-Risk Series,” which identifies federal programs “that are especially vulnerable to waste, fraud, abuse, and mismanagement, or that...more

What's "Hidden" in the 21st Century Cures Act for Health Care Entities

by Nilan Johnson Lewis PA on

The 21st Century Cures Act (Cures) was signed into law December 13, 2016. While the primary focus of the 996-page Act centered on biomedical innovation, several components of Cures have significant implications for health...more

CMS Grants Eleventh Hour Extension for Attesting to Meaningful Use

Providers participating in the Medicare Electronic Health Record (EHR) Incentive Program now have an additional thirteen days to register and attest to meeting the meaningful use requirements for 2016. The Centers for...more

Feb. 13 Deadline Looms for Provider-Based Departments Seeking Mid-Build Exception

by Polsinelli on

A new section of the 21st Century Cures Act provides much-needed relief for hospitals with an off-campus provider-based department (off-campus PBD) that was mid-build or under development as of November 2, 2015 (the Mid-Build...more

CMS Issues Final Rule on New Medicare and Medicaid Conditions of Participation for Home Health Agencies

by Stinson Leonard Street on

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule, 42 C.F.R. pt. 484, implementing significant changes to the conditions of participation (CoPs) that home health agencies (HHAs) must satisfy to...more

CMS Proposes Stringent New Medicare Standards for Providers and Suppliers of Prosthetics and Custom-Fabricated Orthotics

by Reed Smith on

CMS has issued a proposed rule that would set forth qualifications that providers and suppliers must meet in order to furnish, fabricate, or bill for prosthetics and custom-fabricated orthotics under the Medicare program. The...more

Upcoming CMS Call on IMPACT Act Implementation (Feb 23)

by Reed Smith on

On February 23, 2017, CMS is hosting a call on the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) which requires the reporting of standardized patient assessment data by post-acute care provider. The...more

Jan. 31 Deadline: Off-Campus Provider-Based Relocations Requests

by Polsinelli on

For relocations that occurred between 11.2.15 and 12.31.16, providers must submit relocation requests by 1.31.2017. The CY 2017 OPPS Final Rule brought significant changes to the way Medicare reimburses hospitals for...more

OIG Report Cites Continuing Vulnerabilities Under Medicare’s 2-Midnight Policy

by Reed Smith on

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has issued a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Hospital Policy,” which assessed changes in hospital...more

2016 – Health Law Year in Review

We are pleased to present our annual review of developments in the field of health law. The year was marked by key changes in False Claims Act jurisprudence and Medicare payment policy. 2016 also brought with it focused...more

Notes on Day 4 of the JPMorgan Healthcare Conference

Some interesting presentations on the last day of the JPMorgan Healthcare Conference that concentrated on common themes – the increasing importance of ancillary business line to bolster core business revenue and of filling in...more

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