Medicare

News & Analysis as of

New Colorado Durable Medical Equipment Supplier License Requirements Become Effective 12-31-14

Effective December 31, 2014, durable medical equipment (DME) suppliers that do business in the State of Colorado will be required to have a license from the Colorado Secretary of State. In addition, as part of the license...more

Congress Passes Tax Extender Bill With Certain Medicare Cuts

On December 16, 2014, Congress approved a tax extender bill (H.R. 5771) that includes the Achieving a Better Life Experience (ABLE) Act. The ABLE Act provides for tax-free savings accounts for people with disabilities to pay...more

D.C. District Court Dismisses Lawsuit Challenging Backlog of Medicare Appeals

On December 18, 2014, the U.S. District Court for the District of Columbia dismissed a lawsuit filed by the American Hospital Association (AHA) and others to compel the Secretary of HHS to process Medicare reimbursement...more

Health Reform + Related Health Policy News - December 2014, Issue 1

In This Issue: - Top News ..Congress Passes Omnibus Spending Package ..HRSA Cancels Plan for 340B ‘Mega Reg’; Congress Weighs Options ..Supreme Court to Hear Challenge to ACA...more

Two Months After Indictment, Medicare Fraud Mastermind and Doctor Plead Guilty

Mark Morad, the man who cooked up a $56 million Medicare fraud scheme, and his accomplice doctor pled guilty yesterday in federal court in Louisiana to various health care fraud charges....more

CMS Announces Next Phase in Medicare DMEPOS Competitive Bidding Program

On December 11, 2014, CMS announced the bidding timeline for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round 2 Recompete and National Mail-Order...more

CMS Releases Final Rule That Increases Difficulty of Medicare Enrollment

In early December, CMS released a final rule that implements certain provider (i.e., Hospitals, SNFs, physicians, etc.) and supplier (i.e., DME companies, etc.) enrollment requirements (“Rule”). The goal of CMS’...more

CMS Final Rule Adds More Arrows but also Demonstrates Restraint

CMS reconsiders $10 million bounties for reporting of regulatory violations. On December 5, the Centers for Medicare & Medicaid Services (CMS) finalized a rule (the Final Rule) that expands its program integrity and...more

With a New Year Rolls in a New OIG Work Plan

Recently, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) released its Work Plan for Fiscal Year 2015 (“Work Plan”). The OIG protects the integrity of HHS programs by identifying...more

Health Care Update - December 2014 #2

In This Issue: - SGR Replacement Odds Not Likely to Increase Ahead of Upcoming Deadline - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional...more

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

CMS Publishes Correction to CY 2015 Home Health Prospective Payment System Final Rule – On December 2, 2014, CMS published in the Federal Register a correction to its previously published final rule for Medicare Home Health...more

CMS Issues Final Rule Designed to Enhance Agency Oversight of Medicare Providers and Strengthen Protections for Medicare...

On December 3, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (CMS-6045-F) that updates various requirements for providers and suppliers wishing to enroll in the Medicare program. CMS issued...more

Government Applauds Gainsharing, But It's Still Illegal

It's frustrating enough when the government opposes a good idea and makes it illegal. But "gainsharing" presents an even more frustrating situation for hospitals. Why? Because the government continually signals its agreement...more

Keeping Track of the Tracks: Proposed ACO Regulations Alter MSSP Financial Models

Last week, the Centers for Medicare and Medicaid Services (“CMS”) released a new proposed rule for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). This advisory focuses on...more

CMS Proposes Changes to 2016 Star Rating Calculations - Medicare Advantage and Medicare Part D Prescription Drug Plans May Be...

The Centers for Medicare and Medicaid Services (CMS or the Agency) released a memorandum requesting comments regarding proposed changes to the 2016 star ratings systems for Medicare Advantage Plans (MA Plans) and Medicare...more

New CMS Enrollment Rules Strengthen Oversight of Medicare Providers

On December 5, 2014, CMS published a final rule to strengthen its oversight of Medicare providers. The rule includes safeguards designed to prevent providers with unpaid debt from re-entering Medicare and to remove providers...more

Health Headlines: Also in the News - December 2014

CMS Extends Comment Period for Home Health Conditions of Participation Proposed Rule – As previously reported, on October 9, 2014, CMS published in the Federal Register a Proposed Rule that would revise the home health...more

HHS to Audit Hospital Reporting of GPO Payments: GAO Report Suggests Further Scrutiny of GPO Shareback with Hospitals

On November 24, 2014, the Government Accountability Office (“GAO”) published a report examining the contracting practices and funding structures of health care group purchasing organizations (“GPOs”) and their potential...more

OIG Again Approves Medicap Insurer's Contract with Preferred Hospital Network

On October 21, 2014, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 14-10, approving a Medigap insurer’s proposed contract with a preferred hospital network. Similar to...more

CMS Releases New Proposed Medicare Shared Savings Program Regulations

The Centers for Medicare and Medicaid Services (“CMS”) released proposed regulations for the Medicare Shared Savings Program (“MSSP”) on Monday December 1, 2014. The proposed regulations are scheduled to be published in the...more

Global Surgery and 2015 Medicare Physician Fee Schedule

On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery. On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and...more

Impact of Health Care Reform on Provider Liability

In this presentation: - The Changing Healthcare Landscape - Key Features of an ACO/CIN - ACO Standards and Quality Metrics - Examples of Quality Standards - Impact on Board and Corporate...more

CMS Publishes Additional (but Limited) Guidance on the Coverage with Evidence Development Process

On November 20, 2014, the Centers for Medicare and Medicaid Services (“CMS”) published its latest round of guidance on its Coverage with Evidence Development (“CED”) policy for selected items and services under the Medicare...more

OIG Identifies Top 10 Management Challenges for HHS in Fiscal Year 2014

On November 18, 2014, the HHS OIG released its annual list of the top 10 management and performance challenges faced by HHS and the OIG during the current fiscal year, and the new and emerging issues that the OIG anticipates...more

GAO Takes Aim at GPOs

The GAO had drawn a bead on GPOs. In a report issued yesterday the Government Accountability Office expressed concern over the effect of GPOs (group purchasing organizations) on Medicare rates. The report recommended that...more

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