News & Analysis as of

Medicare Benefit Policy Manual

CMS Updates Manual Guidance to Include References to the Two Midnight Rule

by King & Spalding on

Although the Two Midnight Rule was effective October 1, 2013, until recently, CMS had not updated the Medicare Benefit Policy Manual (MBPM) to incorporate the Two Midnight Rule and its revisions to prior admission...more

CMS Updates Manual Provisions for Rural Health Clinics and Federally Qualified Health Centers

by King & Spalding on

On December 31, 2015, CMS updated Chapter 9 of the Medicare Claims Processing Manual and Chapter 13 of the Medicare Benefit Policy Manual addressing payment and certification of Rural Health Clinics (RHCs) and Federally...more

Selected CMS Guidance for Billing for Skilled Nursing Facility Services

by Baker Ober Health Law on

Skilled nursing facilities (SNFs) should take note of the updates and clarifications set forth in Medlearn Matters article 8997, issued by the CMS on March 13, 2015. Medlearn Matters article 8997 updates the chapters in the...more

CMS Issues Refunds For Collections Made On Incorrectly Identified Incarcerated Beneficiary Overpayments

by King & Spalding on

Medicare does not cover supplies or services for persons who are incarcerated at the time the services are rendered. However, Medicare had purportedly paid providers in error for many such claims and sought to recover those...more

Pathology Lab That Cannot Demonstrate Adequate Physician Orders Suffers Medicare Loss

by Baker Donelson on

Much has been written regarding various Medicare policies that may cause a clinical laboratory to suffer the resulting financial consequences when a test requested by a physician is found to be not medically necessary, most...more

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