Healthcare Providers

News & Analysis as of

Comprehensive Care for Joint Replacement: CMS adopts mandatory approach to payment reform

On July 9, 2015, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule that seeks to implement a mandatory episode-based payment model for lower extremity joint replacement (and reattachment) care in...more

AmerisourceBergen Guest Post: Solutions to Overcome Reimbursement Challenges in Personalized Medicine

The continued development and refinement of personalized medicine (PM) has offered an opportunity to revolutionize medical practice and improve outcomes by providing treatments for patients with the notion that “this drug is...more

Breaking News: Proposed 340B Omnibus Guidance Released

The Health Resources and Services Administration (“HRSA”) released an advanced copy of its long-awaited proposed 340B Omnibus Guidance (“Guidance”) today. The document can be found here. Polsinelli is currently reviewing the...more

Responding to Subpoenas and Other Requests for Personal Health Information: Take Them at Face Value

Healthcare providers and other HIPAA covered entities receive requests for protected health information (“PHI”) from a variety of sources on a daily basis. Such requests can range from informal requests made during the course...more

Providers + Retailers - The New Front Door to Health

During last week’s webinar on providers and retail health, the second in a series sponsored by Foley and Oliver Wyman, top executives representing different industry sectors shared their points of view on the challenges and...more

Proposed 2016 Medicare Physician Fee Schedule Includes Changes to Stark Regulations

The Centers for Medicare & Medicaid Services ("CMS") recently released the proposed 2016 Medicare Physician Fee Schedule (the "Proposed Rule"), which includes a number of proposed revisions to the regulations under the...more

Manatt on Health Reform: Weekly Highlights - August 2015 #4

Arkansas's “Private Option” is projected to have a net impact of $438 million on state funds 2017-2021; Iowa selects MCOs for proposed Medicaid managed care transition; and, the DC Marketplace launches a robust dual-language...more

The 60 Day Rule — Identification and Knowing Avoidance

On August 3, 2015, the United States District Court for the Southern District of New York issued an opinion and order in Kane v. Healthfirst, Inc., et al.[1] that provides the first judicial interpretation of the requirement...more

CMS's "At a Collection Agency" Bad Debt Policy - Confusion Continues

As we reported in previous Payment Matters articles, the United States District Court for the District of Columbia has issued inconsistent opinions regarding Medicare's policy not to allow bad debt when that bad debt is still...more

Nearly 2 Million Home Care Workers Now Qualify for Minimum Wage, Overtime Protections

The U. S. Court of Appeals for the District of Columbia Circuit unanimously upheld a Department of Labor (DOL) rule which extended the Fair Labor Standard Act’s (FLSA) minimum wage and overtime protections to certain home...more

Requiring an Employee to Return from FMLA Leave "Without Restrictions" or "Fully Healed" Is Playing with Fire

Do you know what happens when you maintain a policy or practice that requires an employee to return to work without restrictions or “100% healed”? You pay. A lot. Just ask Brookdale Senior Living Communities....more

Companionship Exemption Changes In Effect

The latest twist in the ongoing saga involving the U.S. Department of Labor's changes in its regulatory provisions affecting the Fair Labor Standard Act's Section 13(a)(15) "companionship" exemption and the FLSA's Section...more

Home Health Care Agencies Feeling Sick After Friday’s Circuit Court Ruling

As we reported earlier this year, the U.S. Department of Labor has been fighting nearly 14 months of legal challenges in connection with its attempt to modify the FLSA’s companionship exemption. On Friday, the U.S. Circuit...more

Mississippi CON Report

July 2015 – Mississippi Certificate of Need Meeting - During the July 30, 2015, Certificate of Need meeting, Dr. Mary Currier, State Health Officer, concurred with the health and planning staff analysis and approved the...more

D.C. Circuit Ruling Means DOL’s Home Care Rule May Soon Go Into Effect

On August 21, 2015, the U.S. Court of Appeals for the District of Columbia Circuit (“D.C. Circuit”) upheld the United States Department of Labor’s (“DOL’s”) Home Care Rule and reversed the lower court’s decisions vacating the...more

DOL's Final Rule Upheld By D.C. Court Of Appeals

The D.C. Court of Appeals ruled today that the US Department of Labor's ("DOL") Final Rule on the Application of the Fair Labor Standards Act to Domestic Service (the "Final Rule") is valid, because it is "grounded in a...more

Where Does an Airline Employee File a Workers’ Comp Claim if an Injury Occurred While Traveling?

Turbulence in flight might make passengers nervous. But for flight attendants, it can be the cause of serious injury that may ground them for months or years, sometimes ending their careers. A survey of accidents by...more

Under the Dome: Inside the Maine State House

Under the Dome: Inside the Maine State House provides a high-level overview of recent activity at the Maine State House. House District 19 Special Election - On November 3, 2015 the citizens of Sanford can take...more

Mobile Health Devices and Cybersecurity: Federal Guidance for Management of Threats in Medical Devices

New Technology = New Threats - With new technology comes new security concerns. But when that new technology is in the medical field, the cybersecurity vulnerabilities can be particularly devastating. The...more

Federal Court Rejects Health System's Efforts to Dismiss 60-Day Rule Suit

On August 3, 2015, the United States District Court in the Southern District of New York issued a long-awaited opinion and order rejecting a motion to dismiss filed by the defendants in U.S. ex rel. Kane v. Continuum Health...more

CFPB enters into consent order with company charged with deceptive health care credit enrollment practices

The CFPB has entered into a consent order with Springstone Financial, LLC to settle charges that the company was responsible for alleged deceptive and misleading acts and practices in connection with enrolling consumers in a...more

Court Imposes Potentially Unworkable Burden on Providers Under ACA's Report and Return Rule

In Kane ex rel. U.S. v. Healthfirst, Inc., the federal district court for the Southern District of New York (District Court or Court) provided on August 3 the first and long-awaited interpretation as to when a health care...more

An Analysis of Urinalysis—Considerations for Health Providers

Urinalysis, also referred to as urine drug screening, is an important procedure that health providers use for several reasons: to monitor patients’ medication compliance, detect drug abuse, or identify the presence of...more

Waivers of Co-Pays and Deductibles: Insurance Benefit Exclusions Grow

Recent changes to policy and plan language and increased litigation by third-party payers suggests that out-of-network providers who waive co-pays and deductibles may be in for some rough sailing. Providers must be aware of...more

Antitrust Issues Facing Physicians in Medicaid and Professional Licensing

Physicians who were practicing in the 1990s were involved in numerous attempts to organize themselves in order to be able to participate in and even financially survive the onslaught of managed care delivery systems. The new...more

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