Hospitals Medicare

News & Analysis as of

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS),...more

Federal Court Rejects Hospitals’ Challenge to Medicare Wage Rule 

In a decision with far-reaching implications within the health care industry, on February 22, 2016, a federal judge rejected a challenge to how Medicare reimbursement is adjusted based on local labor costs, dismissing...more

There Is Such a Thing as Being Too Careful

According to The New York Times, Medicare may be punishing hospitals—and academic medical centers (AMCs) in particular—for being too careful. That’s how Northwestern Memorial Hospital’s chief medical officer sees the...more

GAO Recommends Additional Site-Neutral Medicare Payment Policies

On April 13, 2016, the Government Accountability Office (GAO) released another report once again recommending that Congress equalize payment rates for Medicare services across practice settings (e.g., hospital outpatient...more

Ninth Circuit Denies Medicare Payments in Assets-Only Purchase Without Assignment of Provider Agreement

On April 11, 2016, the Ninth Circuit Court of Appeals ruled that a hospital was not entitled to Medicare payments in an assets-only purchase until the Buyer enrolled in the Medicare program because it did not accept the...more

Yet Again, OIG Approves Medigap Policy Contracts with Preferred Hospital Network

On March 11, 2016, the U.S. Department of Health & Human Service, Office of the Inspector General (OIG) issued an advisory opinion approving the use of a preferred hospital network as part of Medicare Supplemental Health...more

Establishing a hospital's per resident amount: Be careful, as the result is permanent!

A teaching hospital's direct graduate medical education (DGME) payments are made on a per resident basis and are based on each hospital’s unique per resident amount (PRA). This PRA, once established, is permanent and cannot...more

Health Law Insights Newsletter - Issue 7 - March 2016

McCarter & English, LLP’s Health Care Group presents Issue 7 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Providers’ Obligation to Report Medicare...more

Court Allows 'Retroactive' Application of 2005 Wage Index Rule Limiting Reimbursement for Pension Plan Costs

On February 22, 2016, in Regents of the University of California v. Burwell, the U.S. District Court for the District of Columbia granted summary judgment in favor of the Secretary of Health and Human Services (the Secretary)...more

The "predicate facts" rule: Providers, be vigilant!

Medicare GME payments do not compensate teaching hospitals for their actual costs of training residents in a given year. Rather, Medicare GME reimbursement is determined, in part, on the basis of historic cost data and...more

Congress introduces bipartisan legislation to help teaching hospitals with vexing "resident rotator" issue

On March 14, 2016, the US Senate and the US House of Representatives both introduced the Advancing Medical Resident Training in Community Hospitals Act. If passed, this legislation would solve the so-called "resident rotator"...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled, “Medicare Program; Part B Drug Payment Model.” The proposed rule seeks...more

Comprehensive Joint Replacement Bundled Payment Program Begins April 1st

Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program applies to...more

CMS Extends EHR Incentive Program Hardship Application Deadline to July 1, 2016

CMS is allowing eligible professionals, eligible hospitals, and critical access hospitals to apply for Medicare Electronic Health Record (EHR) Incentive Program hardship exceptions until July 1, 2016 to avoid adjustments to...more

Recent EHR Meaningful Use Program Updates

As we enter the sixth year of the Medicare and Medicaid Electronic Health Records Incentive Programs (commonly referred to as the “Meaningful Use Programs”), the Centers for Medicare & Medicaid Services (CMS) continues to...more

Wage Index Reclassification Rule Struck Down by Second Circuit

On February 4, 2016, the United States Court of Appeals for the Second Circuit decided Lawrence + Memorial Hospital v. Burwell. The case addressed a regulation, issued by the Secretary of Health and Human Services...more

Significant Telehealth Expansion Proposed in Bipartisan Senate Bill

Earlier this month, a bipartisan group, led by U.S. Senator Brian Schatz (D-Hawaii), introduced a bill in the Senate focused on promoting cost savings and quality care under the Medicare program through the use of telehealth...more

HHS May Be Forced to Meet Statutory Deadlines for ALJ Appeals

On February 9, 2016, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit reversed a district court’s dismissal for lack of jurisdiction in the American Hospital Association v. Burwell case. ...more

House Energy and Commerce Committee Seeks Comments on Changes to Provider-Based Status

On Friday, February 5, 2016, key Republican leaders of the House Energy and Commerce Committee solicited comments from healthcare stakeholders – including hospitals – regarding the impact of payment changes for off-campus...more

Initial residency period (IRP) issues (Part II): What happens when a resident trains longer than expected?

The Medicare program reimburses a higher proportion of a hospital’s per-resident direct graduate medical education (DGME) training costs for the limited period of time required for each resident to become board-certified in...more

Proposed 2017 Budget Savings Proposals Would Impact Providers - But Recent, Significant Decision on RACs May Soon Put Funds Back...

While providers would certainly feel the pinch from the FY 2017 budget request submitted by President Barack Obama, hospitals have some new hope on receiving funds tied up in the Recovery Audit Contractor (RAC) appeals...more

Obama Administration Releases FY 2017 Budget Proposal with Extensive Medicare & Medicaid Funding and Program Integrity Provisions

On February 9, 2016, the Obama Administration released its proposed fiscal year (FY) 2017 budget, which contains significant Medicare and Medicaid reimbursement and program integrity legislative proposals – including $419...more

House Energy & Commerce Committee Seeks Comments on Medicare Site-Neutral Payment Policies

The House Energy and Commerce Committee is seeking input on Section 603 of the Bipartisan Budget Act of 2015, which established a site-neutral payment policy for newly-acquired, provider-based, off campus hospital outpatient...more

CMS Posts Revised Application for Meaningful Use Hardship Exceptions

On January 22, CMS posted a revised application and instructions for a hardship exception from the Meaningful Use program penalties in 2015. Under the new, streamlined application process, which CMS says is a temporary...more

CMS Issues Guide on Avoiding Readmissions in Diverse Medicare Populations

The CMS Office of Minority Health has released a “Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries.” The guide highlights data indicating that racial and ethnic minority...more

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