News & Analysis as of

Insurance carrier ending coverage of physicians under Medicare Advantage contracts

Physicians, healthcare providers, insurers and other interested parties should be aware that a large insurance carrier operating Medicare Advantage plans in Missouri and Illinois recently has begun terminating its...more

CMS Moves to Facilitate Systemwide Governance and Medical Staffs

Last month, the Centers for Medicare and Medicaid Services (CMS) amended its Conditions of Medicare & Medicaid Participation to recognize the increasing movement of hospitals into multi-hospital systems and to facilitate both...more

CMS updates hospital conditions of participation for the medical staff and governing body

On May 12, 2014, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule updating the hospital conditions of participation related to the medical staff and the governing body (“Final Rule”). Specifically,...more

Quantifying and addressing improper payments for Medicare evaluation and management services

A review of Medicare Part B claims for evaluation and management (E/M) services conducted by the Office of the Inspector General (OIG) has found that the program paid $6.7 billion in improper payments in 2010. This figure...more

Health Care: CMS Changes Impact Hospital Governing Body and Medical Staff (5/14)

The Center for Medicare/Medicaid Services (CMS) has pulled back on its recent mandate that a medical staff member serve on a hospital governing board. In lieu of this, CMS now requires that a hospital’s governing body...more

New CMS Rules Reduce Role of Medical Staff

The American Health Lawyers Association Regulatory Accreditation and Payment Practice Group (RAPPG) has issued an email alert regarding the issuance of a final rule by CMS intending to streamline Medicare regulatory...more

Rule Overhaul to Save Health Industry Up To $640 Million, Medicare Says

On May 7, 2014, the U.S. Centers for Medicare & Medicaid Services (CMS) issued a long-awaited final rule in response to President Obama’s Executive Order (EO) 13563, “Improving Regulation and Regulatory Review,” which set as...more

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

CMS Proposes Adoption of Updated Life Safety Code

Wednesday morning, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding adopting the 2012 edition of the Life Safety Code (LSC). CMS states the updated code contains new provisions that are...more

Also in the News

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 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

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

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

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

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

24 Results
|
View per page
Page: of 1