News & Analysis as of

CMS Proposes Elimination of CME Exemption From Sunshine Act

Teaching hospitals and physicians who speak at continuing medical education (CME) programs should be interested in a July 11, 2014, announcement by the Centers for Medicare & Medicaid Services (CMS). The announcement proposes...more

Teaching Hospitals and Physicians Must Take Action Now to Correct Erroneous Reports about them Submitted Under the Sunshine Act

On September 1, 2014, the Centers for Medicare and Medicaid Services (CMS) will make public the reports submitted by pharmaceutical and medical device manufacturers under the Sunshine Act. These reports will disclose...more

New Flexibility Under the Medicare Conditions of Participation: A Single Medical Staff Option for a Multi-Hospital System and...

As described in our prior alert, the Centers for Medicare & Medicaid Services (“CMS”) has, for the past several years, been seeking ways to reduce its regulatory burden on health care providers. In furthering this initiative,...more

You Are Now on the Clock — Sunshine Act Dispute Window Now Open

Beginning Monday, July 14, 2014, the review, dispute and correction process outlined the National Physician Payment Transparency Program (also known as the "Sunshine Act") opens on CMS's Open Payments website. Physicians and...more

OIG Report Recommends Increased Scrutiny of Over 1000 Laboratories With Questionable Billing for Medicare Part B Clinical...

According to a recently released report by the HHS Office of Inspector General (OIG), over 1,000 labs had unusually high billing for Medicare Part B Clinical Laboratory Services for dates of service in 2010. Increased...more

CMS Releases New Resources, Schedules Teleconference for Sunshine Review and Dispute Process

As we informed you last week, the Open Payments review, dispute and correction process started today and will continue through September 11, 2014. This is the process that allows physicians and teaching hospitals to review...more

Newly Released CMS Actuary’s Report Confirms CMS Ignored Impact of Two Midnight Rule on Medical Admissions When Setting 0.2...

On June 30, 2014, King & Spalding filed comments in response to Medicare’s proposed IPPS rule for Fiscal Year (FY) 2015 on behalf of more than 200 hospitals it represents in a federal court challenge to the FY 2014 Two...more

Health Care Reform Implementation Update - June 2014

Secretary Burwell continues to settle in to her new position as the Department of Health and Human Services (HHS), this week making a number of management changes at the department; CMS released the long awaited proposed rule...more

Health Headlines: Also in the News - June 2014 #3

MedPAC Recommends Short- and Long-Term ACO Changes – In a comment letter sent to CMS Administrator Marilyn Tavenner on June 16, 2014, the Medicare Payment Advisory Commission (MedPAC) outlined certain challenges associated...more

Coming Soon To A Hospital Near You: The Five-Star Rating System

You choose your movies, restaurants and hotels based on a five-star system: one star for the worst, five for the best. Why not choose your hospital the same way? That seems to be the reasoning behind yesterday’s...more

CMS Announces Payment Adjustments for Low-Volume and Medicare-Dependent Hospitals

In a notice posted on June 12, 2014, CMS announced changes to the payment adjustment provided to low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment...more

Health Law Insights Newsletter - May 2014

In this Issue: - Federal Updates - State Updates - HIPAA Updates Excerpt from Federal Updates: The Centers for Medicare & Medicaid Services (CMS) issued a final rule to reduce unnecessary or...more

CMS Issues Cost Savings Reforms to Medicare Regulatory Requirements

On May 12, 2014, CMS issued a final rule, reforming certain Medicare regulatory requirements and eliminating those identified as unnecessary, obsolete, or excessively burdensome. Many of the streamlined provisions relate to...more

Medicare's LTCH Moratorium - CMS Issues Instructions and Proposed Regulation

From the early 1980s until the end of the first decade of the 21st century, the number of long-term acute care hospitals (LTCHs) expanded many fold. Addressing this growth, Congress, in enacting the Medicare, Medicaid and...more

CMS Proposal to Adopt New OMB Delineations May Affect Medicare Reimbursement, GME Payments, and Regulatory Compliance

On April 30, 2014, the Centers for Medicare and Medicaid Services (CMS) issued proposed rules for the Fiscal Year 2015 Medicare Hospital Inpatient Prospective Payment System, in which CMS announced several updates, including...more

Changes Proposed to PRRB Dissatisfaction Requirement

On May 15, 2014, CMS published in the Federal Register its FY 2015 IPPS Proposed Rule [PDF], which included changes and updates to its Medicare IPPS policies. 79 Fed. Reg. 27978-28384. One change that CMS proposes is to amend...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

CMS Releases Proposed Rules Allowing Meaningful Use CEHRT Flexibility and Extending Stage 2

CMS recently issued proposed rules that would modify 2014 EHR certification requirements and revise the meaningful use Stage 2 and Stage 3 timeline. In response to industry complaints that many eligible professionals...more

Is It a Violation to Help?

In a May 21, 2014, letter to the President of the American Hospital Association (AHA), U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius confirmed HHS’s position that private, not-for-profit...more

CMS Proposes Change to 2014 “Meaningful Use” Rules

In the May 23, 2014 issue of the Federal Register (79 FR 29732), the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule (the “Proposed Rule”) that would change the so-called meaningful use stage...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

Health Care Reform Implementation Update - May 2014

Congress held several hearings last week ranging from Sylvia Burwell’s nomination for Secretary of the Department of Health and Human Services (HHS), to Medicare payment oversight, to post-acute care in Medicare. The Centers...more

HHS Proposes Extension of Deadline for EHR Compliance

According to the federal government, over 370,000 providers have participated in the Medicare and Medicaid Electronic Health Record ("EHR") incentive program since its inception in 2011. However, providers nationwide continue...more

Proposed 2015 IPPS Rule Contains Many Changes to GME and IME Rules

Each year when CMS publishes its proposed changes to the IPPS Rule, it suggests a number of graduate medical education (GME) and indirect medical education (IME) reforms. This year has been no different. As part of the IPPS...more

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