Medicare

News & Analysis as of

House Approves Medicare Access and CHIP Reauthorization Act

Repeals SGR Formula, Adopts Medicare and Other Policy Changes - Today the U.S. House of Representatives approved a major Medicare package, the Medicare Access and CHIP Reauthorization Act (MACRA), which would reform...more

Placing Medicare Beneficiaries Into "Observation Status" - Recent Second Circuit Decision Casts Doubt on Lawfulness of CMS...

The trend toward placing more Medicare beneficiaries into observation status in the hospital has come under increasing attack by patient advocates. Such patients are considered outpatients reimbursed by Medicare Part B rather...more

No SGR Action by Senate

Senate leaves for recess with no action on SGR repeal - Despite a successful vote in the House yesterday, the Senate failed to bring to a vote legislation to repeal the flawed Medicare Sustainable Growth Rate (SGR)...more

MedPAC Issues March 2015 Report to Congress on Medicare Payment Policies

On March 13, 2015, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to the Congress on Medicare payment policies (Report). The Report includes recommendations for inflation updates and payment...more

House Plans to Vote Thursday on Medicare Physician Payments, CHIP Extension Legislation

After a decade of short-term actions, congressional leaders are pushing this week to permanently repeal the Sustainable Growth Rate (SGR) formula that governs Medicare physician payment rates, and replace the system with one...more

Is Health Care Fraud on the Rise? Or Just the Accusations??

Recent stories in the news seem to suggest that health care fraud is running rampant. We’ve got stories about Eric Leak‘s Medicaid agency, Nature’s Reflections, funneling money to pay athletes, a seizure of property in...more

Timeline tightens for provider, supplier responses to MAC and ZPIC requests starting April 6, 2015

MAC and ZPIC reviewers have the right to request additional documentation when a claim itself is insufficient to make a payment determination. Effective April 6, 2015, in response to a pre-payment review and additional...more

Can Retirees Use HSAs?

Yes – and no. A Health Savings Account (HSA) is like an IRA but for the payment of medical expenses instead of retirement income. HSA contributions are not taxed, and like IRA accounts, they belong to the employee. ...more

HHS Releases List of 25 Unimplemented Recommendations to Save Money and Improve Quality in Medicare and Medicaid

On March 16, the Office of Inspector General of the U.S. Department of Health and Human Services released the Compendium of Unimplemented Recommendations, an 83-page document that identifies 25 priorities for saving money and...more

Washington Healthcare Update

This Week: Bipartisan, Bicameral Permanent SGR Fix Introduced... House Budget Committee Advances FY2016 Budget Proposal... National Coverage Determinations Proposed for Removal... HHS Releases Proposed Rules on EHR Incentive...more

Congressional Leaders Introduce Legislation to Repeal Medicare's SGR Formula, Increase Physician Reimbursement Rates

A group of bipartisan, bicameral congressional leaders introduced a bill, on March 19, to repeal the Sustainable Growth Rate (SGR) formula that governs Medicare physician payment rates. The formula has called for dramatic...more

Ways & Means Committee Schedules March 24 Hearing on Use of Data Analysis to Stop Medicare Fraud

On March 24, the House Ways and Means Subcommittee on Oversight is holding a hearing on CMS’s use of the Fraud Prevention System (FPS) to identify and stop Medicare fraud. ...more

MedPAC Report to Congress on Medicare Policy

The Medicare Payment Advisory Commission (MedPAC) has released its annual recommendations to Congress on Medicare policies, including Medicare fee-for-service (FFS) payment updates and a status report on the Medicare...more

GAO Calls for Expanded HHS Efforts to Reduce Antipsychotic Drug Use in Community Settings

The Government Accountability Office (GAO) has issued a report examining the extent to which antipsychotic drugs are prescribed for older adults with dementia in nursing homes and other settings. ...more

Fox Hollow Technologies Agrees to Settle False Claims Act Allegations

The United States Department of Justice recently announced that ev3 Inc., a company that recently acquired Fox Hollow Technologies, agreed to pay a $1.25 million penalty to settle accusations that Fox Hollow had committed...more

CMS Finalizes SMART Act MSP Appeals Provisions

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that implements Medicare Secondary Payer (MSP) appeals provisions under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act). ...more

OIG Reviews Medicare Reimbursement for Critical Access Hospital (CAH) Swing-Bed Services

A recent OIG report examines increasing use of CAH “swing-bed” services, which the OIG describes as being equivalent to services performed at a SNF, but which are reimbursed at 101% of a CAH’s reasonable cost rather than at...more

CMS Announces Next Generation ACO Model

CMS announced a new ACO payment initiative on March 10, 2015, the Next Generation ACO Model, designed for entities experienced in coordinating care for populations of patients. The announcement reflects CMS’ commitment to...more

Health Care Update - March 2015 #3

In This Issue: - Permanent Medicare Doc-Fix Could be a Reality, CHIP Reauthorization May Be Lynchpin - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives -...more

CMS Publishes Final Rule Establishing Appeal Process for Applicable Plans in Medicare Secondary Payer Cases

On February 27, 2015, CMS published a final rule, effective April 28, 2015, to establish a formal, multilevel administrative appeals process for applicable plans against which Medicare Secondary Payer (MSP) recovery demands...more

HHS Secretary Burwell Testifies in House Appropriations Hearing Regarding Medicare Appeals Backlog

On February 25, 2015, HHS Secretary Sylvia Burwell testified in a budget hearing before the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, about the Obama...more

New Postings on the Reed Smith Health Industry Washington Watch Blog

The Reed Smith Health Industry Washington Watch blog has been updated to report on recent health policy developments, including the following...more

Next Generation ACOs: CMMI Doubles Down on the Two-Sided Risk ACO Model

While one part of the Affordable Care Act, exchange subsidies, hangs in the balance with the Supreme Court’s upcoming decision in King v Burwell, CMS is moving forward aggressively with the evolution of a less controversial...more

OIG Wants CMS to Take a Scalpel to Surgery Costs

The Office of Inspector General (OIG) of Health & Human Services is recommending that CMS make a major reduction to the amount it pays hospitals for certain kinds of surgery. ...more

Judge Orders State’s Termination of Provider’s Medicaid Contract To Be REVERSED, Despite the Unilateral Termination!!

Imagine that the State of North Carolina knocks on your office door and informs you that you are no longer allowed to accept Medicaid and/or Medicare reimbursement rates. That for whatever reason, you are no longer allowed to...more

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