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Medicare Claim Procedures

WilmerHale

In Narrow Victory for Tribal Nations, US Supreme Court Requires Federal Government to Reimburse Tribal Nations for Healthcare...

WilmerHale on

On June 6, 2024, the US Supreme Court decided Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe (Nos. 23-250 and 23-253), holding that the Indian Health Service (IHS) must reimburse Native nations,...more

Holland & Knight LLP

Tribes: Act Now to Take Advantage of Supreme Court's Decision on Contract Support Costs

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The U.S. Supreme Court ruled on June 6, 2024, that the Indian Health Service (IHS) must pay contract support costs with respect to program income – payments from Medicare, Medicaid and private insurers – received by tribes...more

Bricker Graydon LLP

CMS announces restart of Review Choice Demonstration for Ohio home health agencies

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Home health agencies (HHAs) in Ohio had a brief reprieve from the audits of their Medicare claims under the Review Choice Demonstration (RCD), but that reprieve is about to end. ...more

Proskauer - Employee Benefits & Executive...

Updated Health Care Reform Legislation Comparison Chart

The chart below compares key provisions of the Affordable Care Act (ACA), the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). This chart is current as of July 13, 2017, and as of that date,...more

Polsinelli

New Restrictions: CMS Limits Scope of Review on Redeterminations and Reconsiderations for Certain Audit Appeals

Polsinelli on

On August 13, 2015, the Centers for Medicare & Medicaid Services (CMS) issued instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for...more

Baker Donelson

CMS Waves Partial White Flag in Appeals of Payment Status Denials

Baker Donelson on

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

Baker Donelson

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

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In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

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