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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

CMS Releases FY 2015 Hospital Wage Index Development Timetable

CMS has released the Wage Index Development Timetable for FY 2015. This is the schedule that governs the review and corrections process for hospital wage index values. According to the Timetable, CMS will release two...more

CMS Proposes Changes to Modernize and Update the Clinical Laboratory Fee Schedule

On July 8, 2013, the Centers for Medicare & Medicaid Services (CMS) released a pre-publication version of the 2014 Medicare Physician Fee Schedule and the 2014 Medicare Hospital Outpatient Prospective Payment System Notices...more

CMS Releases Proposed Calendar Year 2014 Updates to Home Health Prospective Payment System

On June 27, 2013, the Centers for Medicare & Medicaid Services (CMS) released its proposed Calendar Year 2014 rate update to the Home Health Prospective Payment System. In addition to reducing reimbursement rates, CMS is...more

CMS Clarifies Physician Delegation of Tasks in SNFs and NFs

The Centers for Medicare and Medicaid Services (“CMS”) released an important instruction for physicians, non-physician practitioners (“NPPs”) and providers who bill for services provided in skilled nursing facilities (SNFs)...more

Here Comes the Sun: What You Need to Know about the Sunshine Act and Its Implementing Rules

After years of deliberation, the Center for Medicare & Medicaid Services (CMS) published its long-awaited regulations to implement the specific requirements of the Physician Payment Sunshine Act (Sunshine) on February 1,...more

CMS Issues Proposed Rule to Reform "Unnecessary, Obsolete, or Excessively Burdensome" Medicare Participation Standards

On February 4, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to reform Medicare regulations that CMS views as unnecessary, obsolete, and/or excessively burdensome on hospitals and health care...more

Recent PRRB and CMS Administrator Decisions: A Summary for Providers

In recently released decisions, the PRRB and the CMS Administrator addressed a number of issues of interest to many providers. Short summaries of those decisions are provided below. The PRRB and CMS Administrator post their...more

Physician Payment Sunshine Act: Challenge for Companies, Tool for Enforcers

Pharmaceutical companies, medical device manufacturers, and biotech companies are gearing up for the January 1, 2013 deadline set by the Centers for Medicare and Medicaid Services (“CMS”) for companies to begin collecting...more

Medicare Audit Challenges to Paying Nursing and Allied Health Program Pass-Through Costs

The Medicare program shares in the costs for approved nursing and allied health education programs operated by hospitals, a matter which has become a recent focus in Medicare audits of hospitals operating such programs....more

Telemedicine Amidst Healthcare Reform: Practicalities and Pitfalls

The Supreme Court’s recent decision upholding the Patient Protection and Affordable Care Act underscores the need to deliver and make accessible quality healthcare to patients throughout the United States in an efficient and...more

CMS Announces it Will Not Require Data Collection by Manufacturers under the Physician Payments Sunshine Act Before January 1,...

Margaret Tavenner, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS or the “Agency”), issued a letter to Senator Chuck Grassley on May 3, 2012 formally responding to a letter sent to her by Senator...more

CMS Delays Data Collection Under ACA's Physician Payments Sunshine Act to January 1, 2013 May 9, 2012

On May 3, 2012, the Centers for Medicare and Medicaid Services (CMS) officially announced that it will delay data-collection and reporting requirements under the Patient Protection and Affordable Care Act's (ACA) Physician...more

Shorts on Long Term Care - May 2012

In this issue: - A Sign of the Times: Nonpayment of Resident Accounts, Transfer/Discharge and Related Issues - Responding to an Audit? Be Prepared! - Ken’s Quote of the Month An excerpt from...more

Sunshine Act Implementation Delayed Until 2013

With little fanfare, the Centers for Medicare & Medicaid Services (CMS) announced today on the CMS Blog that it is delaying data collection under the Sunshine Act until 2013. Pharmaceutical and medical device manufacturers...more

What Hospitals and Physicians Need to Know about CMS’s Proposed Rule Interpreting the Physician Payment Sunshine Act

Centers for Medicare & Medicaid Services (CMS) issued on December 14, 2011 its much-anticipated proposed rule interpreting the requirements of the Physician Payment Sunshine Act (Act), enacted by Congress as Section 6002...more

Proposed Physician Payment Sunshine Act Regulations Leave Many in the Dark

Originally published in Health Care Fraud Report, 16 HFRA 80, 01/25/2012. Pharmaceutical and medical device manufacturers as well as group purchasing organizations (GPOs) finally received some insight into how the...more

Payment Matters: CMS Instructs Teaching Hospitals on Reporting FICA Tax Refunds for Medical Residents

On March 10, 2010, the IRS determined that medical residents are exempt from FICA taxes based on the student exception, for tax periods ending before April 1, 2005. Although the refunds apply to tax periods ending before...more

CMS Issues Proposed Sunshine Act Regulations

Bright-Light Scrutiny on Payments by Drug and Device Makers to Physicians and Teaching Hospitals and Certain Physician Ownership Interests The Centers for Medicare and Medicaid Services (CMS) published in the Federal...more

CMS Delays Implementation of the Physician Payment Sunshine Act

Considerably after the statutory deadline of October 1, 2011, the Centers for Medicare and Medicaid Services (CMS) finally has issued proposed regulations aimed at implementing what is known as the "Physician Payment Sunshine...more

"Sunshine Act Begins to See Light of Day: CMS Issues Proposed Rule Implementing Physician-Payment Reporting Requirements"

On December 14, 2011, the Centers for Medicare and Medicaid Services (CMS) released its long-awaited proposed rule to implement Section 6002 of the Affordable Care Act (ACA), commonly known as the Physician Payment Sunshine...more

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