News & Analysis as of

Medicare Shared Saving Program Interim Final Rule Extended

On October 17, 2014, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services, Office of Inspector General (OIG) published in the Federal Register (79 FR 62356 et seq) a notice...more

Manatt on Health Reform: Weekly Highlights

Welcome to the first publication of the “Manatt on Health Reform: Weekly Highlights” newsletter. Many of you are familiar with the healthcare reform tracking efforts and weekly newsletters we produced for the KidsWell...more

Pioneer ACOs: Slowed Health Spending, Improved Quality and More Drop Outs?

The Centers for Medicare and Medicaid Services (CMS) recently released second year results on its Pioneer Accountable Care Organization (ACO) program. The Pioneer ACO program is CMS’ ambitious foray into the ACO space and a...more

Big Changes to Administrative Law Hearings for Medicare Providers

Effective October 27, 2014, the Medicare Program Integrity Manual (“Manual”) will require Medicare Administrative Contractors (“MACs”) to participate in administrative hearings concerning medical review decisions. ...more

Changes Coming to Nursing Home Compare

The Centers for Medicare and Medicaid Services (“CMS”) has announced that the Nursing Home Compare Five Star Quality Rating System will soon undergo some changes. The rating system has experienced recent criticism for relying...more

Health Care Update - October 2014 #3

In This Issue: - Policymakers Scrambling to Contain Ebola Crises - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional Initiatives -...more

Health Headlines: Also in the News - October 2014 #2

CMS Announces Changes to the Nursing Home Quality Rating System – On October 6, 2014, CMS announced upcoming changes to the nursing home five-star quality rating system. The changes include revising the scoring methodology...more

CMS Releases New, Proposed Home Health Conditions of Participation

CMS published a proposed rule on Thursday, October 9th, 2014, updating the Home Health Agency (HHA) Conditions of Participation (CoPs). The proposed rule represents the first update to the HHA CoPs since 1989. Comments are...more

Front End Changes and, Again, More DIR Columns

Since the beginning of the Medicare Part D program, CMS has introduced many reporting mechanisms for trying to understand drug pricing, price concessions, and the cost of providing services to Part D members. The tool CMS...more

Health Care Reform Implementation Update

In the past week, CMS has released several advisories including updates to the rating system for nursing homes, premium and deductible information for Medicare Part B and Part D for 2015, Pioneer ACO results, payment dispute...more

CMS Announces Program to Fund ACO Growth, Extends Fraud and Abuse Waivers

The Centers for Medicare & Medicaid Services (“CMS”) announced a new initiative, the ACO Investment Model, on October 15, 2014. Under the model, ACOs which are made up of “providers [who] lack adequate access to … capital”...more

Critical Access Hospital Soothsayers and the 96-Hour Physician Certification Requirement

This year critical access hospitals (CAH) have struggled to implement procedures to comply with both the "two-midnight" rule and the 96-hour physician certification requirement. The combination of both puts physicians in a...more

CMS Reopens Application Period for Meaningful Use Hardship Exception

CMS Reopens Application Period for Meaningful Use Hardship Exception - the period during which certain eligible providers may request a hardship exception from qualifying as a Meaningful User under the Medicare EHR Incentive...more

CMS Proposes Revisions to Home Health Conditions of Participation

On October 9, 2014, CMS published in the Federal Register a Proposed Rule that would revise the home health Conditions of Participation (CoPs). The home health CoPs have not been updated since 1989. Although CMS previously...more

CMS Issues New Cost Reporting Instructions

CMS recently released a transmittal updating Chapter 40 of the Provider Reimbursement Manual and the Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10). ...more

Health & Human Services, Office of Inspector General, Proposes New Fraud and Abuse Rules

The U.S. Department of Health & Human Services, Office of Inspector General (OIG) published 79 Fed. Reg. 59717 on October 3, 2014. This proposed rule has the potential to have an impact on a broad array of financial...more

Health Care Update - October 2014 #2

In This Issue: - First Look at Pioneer ACO Data Reveals Murky Path Forward - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional...more

CMS Issues 2013 RAC Report to Congress

On September 29, 2014, CMS released the Fiscal Year (FY) 2013 Recovery Audit Contractor (RAC) report. According to the report, RACs collected $3.65 billion in Medicare overpayments during FY 2013. In addition, the report...more

CMS Makes Limited Time Offer to Settle RAC Claims Pending Appeal

The Centers for Medicare and Medicaid Services (CMS) made an offer to settle currently pending RAC appeals for partial payment of 68 percent of the net claim amount if a hospital agrees to withdraw all of its RAC appeals. The...more

CMS Cost Sharing Reduction Reconciliation Reporting for QHPs

Qualified Health Plans (“QHPs”) and other stakeholders have until October 27, 2014, to comment on CMS’s proposed cost sharing reduction payment reconciliation reporting process. On Friday, September 26, 2014, CMS released...more

Prepare for Changes to CMS’ Five Star Quality Rating System for Nursing Homes

Choosing a nursing home can be a daunting task for consumers who often have myriad questions regarding the quality of care available at the nursing homes in their areas. To help answer these questions, CMS has created the...more

CMS Publishes Open Payments Data Detailing Payments and Transfers of Value Provided by Life Sciences Manufacturers to Physicians...

On September 30, 2014, CMS published data regarding payments and transfers of value that pharmaceutical, biologic, and medical device manufacturers provided to U.S. physicians and teaching hospitals during the period August 1...more

CMS Offers To Settle All Acute Care Inpatient Claim RAC Appeals

CMS is offering to pay hospitals 68 percent of the allowable amount for all claims that are currently on appeal. Specifically, CMS is offering to settle "inpatient status" claims at 68 percent of the "net paid amount" within...more

Health Care Update - October 2014

In This Issue: - CMS Publishes Long-Awaited “Health Plan Innovation Initiative” RFI - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional...more

Health Law Alert: Case Against New York Health System May Shape the 60-Day Overpayment Rule

New York’s Mount Sinai Health System is involved in a high-stakes False Claims Act (FCA) suit alleging failure to comply with the Affordable Care Act’s (ACA) 60-day overpayment rule. This is the first time the Department of...more

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