News & Analysis as of

Hospitals Medicare

Tennessee CON Report

I. August 2017—Tennessee Certificate of Need Meeting - The agency approved the following applications during the August 23 meeting. A. Consent Agenda - 1. Vanderbilt University Medical Center, Nashville (Davidson...more

Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020

by Baker Ober Health Law on

Hopes were dashed for sooner relief from the backlog of Administrative Law Judge (ALJ) appeals. With the backlog of Medicare reimbursement appeals steadily growing, a reversal by the U.S. Court of Appeals for the District of...more

What Exactly Is a Hospital, Anyway? CMS Issues Guidance on “Primarily Engaged” Medicare Certification Requirement

The rules that govern participation in the Medicare program are notoriously voluminous and complex. Indeed, courts have described them as akin to a “[body of] law written by James Joyce and edited by E.E. Cummings” and “among...more

When Is a Hospital Not a Hospital? New Guidance Sheds (Some) Light on the Definition

by McDermott Will & Emery on

The Centers for Medicare and Medicaid Services released guidance on September 6, 2017, intended to clarify the definition of “hospital.” The guidance provides factors that may be considered to determine whether a hospital is...more

New CMS Guidance on Inpatient Engagement Necessary for Hospital Certification

by McGuireWoods LLP on

On Sept. 6, 2017, the Centers for Medicare and Medicaid Services (CMS) issued an advanced copy of guidance to state survey agency directors that is intended to clarify how to determine whether a hospital seeking Medicare...more

Emergency Medicare GME affiliation agreements

by Dentons on

Hurricane Harvey, which is currently devastating the Houston area, reminds us that natural disasters and other emergencies outside a hospital's control may sometimes make it impossible for a teaching hospital to continue...more

Healthcare Law Update: September 2017

by Holland & Knight LLP on

OIG Advisory Opinions - Manufacturer's Free Replacement of Spoiled Pharmaceutical Products Authorized - On Aug. 25, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG)...more

Final Medicare Payment Regulations Expected for Physician Providers, Hospitals and Home Health Agencies in Fall 2017

by Baker Donelson on

The Centers for Medicare & Medicaid Services (CMS) released several annual Medicare proposed payment rules over the summer that are expected to be finalized this fall for 2018. On July 13, CMS released the proposed 2018...more

CMS Proposes Reimbursement Cuts for Certain Hospital Provider-Based Departments

by McGuireWoods LLP on

Non-excepted hospital off-campus provider-based departments (PBDs) may once again face cuts to reimbursement during calendar year 2018 (CY 2018) if the Centers for Medicare & Medicaid Services (CMS) finalizes proposed changes...more

Hospitals and Others Respond to “Red Tape Relief Project” Requests

Last week, a number of health care industry associations sent letters to Congress detailing ways in which the government could relieve them of the burdens associated with “red tape.” The letters are in response to the first...more

CMS Aims to Nix Obama-Era Payment Models

In a proposed rule published Tuesday, August 15, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its intention to roll back a handful of payment models introduced under the Obama Administration. If...more

Value-based health care: the role of payors

by Ropes & Gray LLP on

Bill Knowlton, Ropes & Gray health care partner, examines the critically important role of payors in value-based health care programs. ____________ Payors are critically important to value-based health care because they're...more

Court Says HHS Must Justify Methodology for Outlier Payments

by King & Spalding on

On August 18, 2017, the United States Court of Appeals for the District of Columbia ruled that HHS had inadequately justified its inclusion of data from hospitals that allegedly “turbo-charged” their cost-to-charge ratio when...more

CMS Merely Soliciting Comments on Including Total Joints as ASC Procedures

by Tucker Arensberg, P.C. on

CMS released the proposed update for the Hospital Outpatient Perspective Payment System and the Ambulatory Surgery Center System on July 13, 2017, and the release has generated some unexpected controversy regarding the...more

Hospitals Plagued by HHS's 2012 Medicare DSH Calculation Obtain Relief from the D.C. Circuit

by Baker Ober Health Law on

Hospitals affected by HHS's 2014 decision to include Medicare Part C enrollees as part of the Medicare fraction of the disproportionate share calculation obtained relief late last month when that position was voided by the...more

Back to School Rules Recap: Hospital and Physician Cheat Sheet on What CMS Did This Summer

by BakerHostetler on

Summer was no vacation for the Centers for Medicare & Medicaid Services (CMS). The agency released a series of significant rules that signal the nature and pace of CMS Medicare payment and policy changes for hospitals and...more

CMS revises CJR program, cancels cardiac bundles

by Thompson Coburn LLP on

On Aug. 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule seeking to reduce mandatory participation requirements in the Comprehensive Care for Joint Replacement (CJR) program for hospitals...more

Medicare Claims Appeals: D.C. Circuit Reverses and Remands in Case Seeking Relief From Processing Delays

by Foley & Lardner LLP on

On August 11, 2017, the D.C. Circuit reversed the district court and held that the district court abused its discretion by ordering the Secretary of HHS to clear the backlog of administrative appeals of denied Medicare...more

K&L Gates Triage: 340B Eligibility - Hospital Covered Entities

by K&L Gates LLP on

This podcast focuses on the eligibility requirements for hospitals participating in the 340B Drug Pricing Program. Factors affecting eligibility include a hospital’s licensure status, patient population, and Medicare...more

CMS Proposes to Cancel Bundled Payment and Incentive Models

The U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule last week regarding the cancellation of three bundled payment models and an incentive payment model while also reducing the scope of a third...more

Blog: OIG Releases August Work Plan Items

by Cooley LLP on

As we recently announced, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The August updates released this week include 4 new Work Plan items:...more

CMS Proposes Cancellation of Medicare Cardiac/Hip Fracture Episode Payment Models, Scale-Back of Mandatory CJR Participation

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has just released a proposed rule to cancel a significant — but still-pending — Obama Administration program that would require certain hospitals to participate in Medicare...more

California Hospitals Successfully Beat Back Medicaid Payment Cut

by King & Spalding on

Almost a decade ago, California submitted a State plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) that would retroactively implement a ten-percent rate reduction in outpatient services provided to...more

EMTALA Settlement Highlights Continuing Challenges for Hospitals

After 30 years as a fixture in the federal healthcare regulatory landscape, the Emergency Medical Treatment and Labor Act—more commonly known as EMTALA—has been in the news again. In the past year, the U.S. Department of...more

DC Circuit Court Remands Medicare Appeals Backlog Case

by King & Spalding on

Last week, the United States Court of Appeals for the District of Columbia Circuit reversed and remanded the Medicare appeals backlog case American Hospital Association v. Price to the district court. As previously reported,...more

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