Medicare

News & Analysis as of

New Year, New Possibilities: OIG Final Rule Amends Beneficiary Inducement Rules

The Office of Inspector General (“OIG”) of the Department of Health and Human Services has issued a final rule (“Final Rule”) adding new safe harbors to the federal anti-kickback statute, amending existing safe harbors, and...more

The Old and the New – Day 3 Notes from the JPMorgan Healthcare Conference

Day 3 of the JPMorgan healthcare conference was one of striking contrasts between the old and the new. (And, by the way, the rain finally stopped for a day, but it will be back tomorrow to finish off the last day of the...more

Judge Denies HHS’s Request to Rescind Timeline to Eliminate the Medicare Appeals Backlog

On January 4, 2017, the court in the American Hospital Association (AHA) v. Burwell litigation denied HHS’s motion to reconsider, which means that HHS must comply with the court’s timeline to eliminate the Medicare appeals...more

Urban hospitals that established GME caps after 1996: Be careful with this compliance issue

If a teaching hospital meets certain regulatory requirements, the hospital is generally permitted to loan its cap slots to other hospitals through a Medicare GME affiliated group agreement. (See Sharing FTE Caps: Threshold...more

CMS to Host Call on Transitioning Physician Quality Reporting to MIPS (Jan. 24)

On January 24, 2017, CMS is hosting a call to discuss how to complete the final reporting period for the “legacy” Medicare physician quality reporting programs (Physician Quality Reporting System, Medicare Electronic Health...more

HHS OIG Revises Various Safe Harbors Related to Beneficiary Inducements

On Dec. 7, 2016, the U.S. Department of Health and Human Services’ (HHS’) Office of Inspector General (OIG) published a final rule revising federal Anti-Kickback Statute (AKS) safe harbors and the beneficiary inducement...more

CMS Corrects Final 2017 OPPS/ASC Rule, Results in Slight Payment Increase

CMS has published a notice correcting technical errors in its November 14, 2016 final rule with comment period updating the Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center payment...more

Looking Forward/Looking Backward – Day 1 Notes from the JPMorgan Healthcare Conference

A large amount of wind, much discussion about the U.S healthcare, and the public getting soaked again – if you were thinking about Washington, DC and the new Congress, you’re 3,000 miles away from the action. This is the week...more

Health Reform Outlook for 2017: A Year of Major Uncertainty

Fulfilling their promises, Congressional Republicans moved to repeal the Affordable Care Act (ACA) on the first day of the new Congress when Senate Budget Committee Chair Michael Enzi (R-WY) introduced “reconciliation...more

Repealing Obamacare Will Have Consequences for Medicare

One of President-elect’s Donald Trump's campaign promises was to repeal the Affordable Care Act (ACA), aka Obamacare, and Republicans in Congress have vowed to make repeal one of their first acts in the new term. While...more

New billing modifier required for services furnished at certain off-campus provider-based departments on or after January 1, 2017

Changes to Medicare billing and payment rules for services furnished at certain off-campus provider-based departments (PBDs) went into effect on January 1, 2017. Pursuant to the statutory “site-neutral” payment policy enacted...more

2016 Nerve-of-a-Burglar Award

Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid. Nevertheless, we have a clear winner: the Michigan...more

Capitol Hill Healthcare Update

A growing number of moderate and conservative Republicans in Congress are voicing concerns about the party’s strategy to repeal the Affordable Care Act (Act) in February but then wait months – and possibly even into 2018 –...more

The New “Price” of U.S. Health Care: The Future of Value-based Reimbursement Under President-elect Trump and Tom Price

The total U.S. health care expenditure was $3.2 trillion in 2015, and is projected to grow to nearly $5.6 trillion by 2025. As our nation’s cost of care rises, both Democrats and Republicans recognize the overwhelming need to...more

Episode 06: Obamacare (Part II): What Happens Next? [Audio]

Matt and Beth return to discuss the "repeal and replace" debate (and help separate fact from fiction), practical insights about the Trump administration's Department of Health and Human Services and Centers for Medicare and...more

The AHA’s Letter to Santa Claus

The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717...more

Removing Barriers to Telehealth in Oklahoma: Increasing Access to Care and Improving Health Outcomes Across the State

Imagine that today is July 1, 2014, and you live in north Tulsa, a statistically poor area of the city. You receive health coverage through Oklahoma’s Medicaid program, SoonerCare, you have a terrible sore throat, and you...more

Medical Malpractice and Healthcare Quarterly - Winter 2016

Delaware Superior Court Clarifies “Wrong Body Part” Exception to Affidavit of Merit - The Delaware Superior Court recently dismissed a plaintiff’s claim against a physician and clarified the meaning of one of the...more

“Bundles of Bundles”: CMS Announces New Mandatory Bundled Payment Programs for Heart Attack, Heart Surgery, and Hip and Femur...

The Centers for Medicare and Medicaid Services (“CMS”) is forging ahead with the implementation of innovative and value-based payment programs, despite Donald Trump’s win in the presidential election and Republican...more

Researchers see ways Obamacare helped to cut costs, improve patient care

As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the...more

Overcoming the obstacles and realizing the benefits of a chapter 11 healthcare restructuring

Many healthcare businesses, both for-profit and not-for-profit, have faced financial distress. Among the factors that may contribute are lower reimbursement rates, changes in the delivery of services, regulatory shifts, and...more

A Condition of Participation for Medicare Providers in 2017

This year, Medicare providers and suppliers — including hospitals, ambulatory surgical centers (ASCs) and end-stage renal disease (ESRD) facilities — will need to develop emergency preparedness plans for both natural and...more

Capitol Hill Healthcare Update

Republican congressional leaders overseeing the new 115th Congress will trigger a legislative process this week which will likely culminate in February with the repeal of most of the Affordable Care Act (ACA). The Senate will...more

HHS OIG Issues Report on Medicare’s 2-Midnight Rule

On December 19, 2016, the HHS OIG issued a report on Medicare’s 2-midnight rule titled “Vulnerabilities Remain Under Medicare 2-Midnight Hospital Policy.” The report reviews data from 2013 and 2014 and reaches several...more

“Should Auld Acquaintance Be Forgot” - Performant to Initiate Home Health, Hospice, and DME Audits in 2017

The final quarter of 2016 ended with the Centers for Medicare & Medicaid Services (CMS) announcing Performant Recovery, Inc. (Performant) as the new national Recovery Audit Contractor (RAC) to focus solely on Home Health,...more

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