Medicare, CMS | JD Supra Law News

Bringing Sunlight to Healthcare Pricing: The CMS Release of Hospital Charge Data

by Robert Wolin | BakerHostetler on 5/17/2013

Former U.S. Supreme Court Justice Louis D. Brandeis once said that "Sunlight is the best disinfectant." The release of charges billed by some 3,337 Medicare hospitals for 100 of the most common inpatient diagnosis related...more

Increased Spotlight on Emergency Department Facility Coding by CMS, HHS and DOJ

by Gregory Brodek | Duane Morris LLP on 5/16/2013

Although the professional component of coding for evaluation and management services ("E&M Services") has been scrutinized over the years, until recently, little attention has been given to coding practices for the facility...more

Health Care Reform Update -- May 13, 2013

by Joseph P. Hammang, Alexander Hecht, Abby Matousek, Jeremy Rabinovitz | Mintz Levin - Health Law on 5/15/2013

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

CMS Delays Edits to Deny Claims When Ordering/Referring Provider Not Enrolled in Medicare and Issues Proposed Rule on Enrollment...

by Joan Polacheck, Monica Wallace | McDermott Will & Emery on 5/13/2013

The Centers for Medicare & Medicaid Services temporarily delayed the implementation of edits relating to ordering/referring practitioners that were scheduled to go into effect May 1, 2013, and issued a proposed rule with...more

Weigh In with Comments on CMS Proposed Rule for Medicare IRP by June 28

by Stephen Azia, Danielle Trostorff | Baker, Donelson, Bearman, Caldwell &... on 5/13/2013

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled "Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment" on April 29, 2013. This proposed rule,...more

CMS Issues Proposed Hospice Payment Update for FY 2014

by King & Spalding on 5/9/2013

On April 29, 2013, CMS issued a proposed rule providing the payment rates and wage index for hospices effective FY 2014. While the proposed rule describes current findings and offers options for consideration, it does not...more

Health Care Reform Update -- May 6, 2013

by Joseph P. Hammang, Alexander Hecht, Abby Matousek, Jeremy Rabinovitz | Mintz Levin - Health Law on 5/8/2013

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups Scheduled....more

Phase Two Edits - Temporarily on Hold

by Donna Senft | Ober|Kaler on 5/3/2013

In its April 25, 2013 Medicare FFS Provider e-News, CMS announced that due to “technical issues” it would be delaying the implementation of the Phase 2 claims edits. ...more

Recent Court Decisions Affecting DSH Percentage Calculations May Impact Participation in the 340B Drug Discount Program

by Christine Morse | Ober|Kaler on 5/3/2013

A number of recent developments affecting the Disproportionate Share Hospital (DSH) percentage calculation methodologies will likely have significant impact on 340B covered entities. DSH hospitals that participate in the 340B...more

CMS Proposes Prospective Payment System Update Rules for Inpatient and Long Term Care Hospitals

by Colin Roskey | Cozen O'Connor on 5/2/2013

On Friday, April 26, the Centers for Medicare and Medicaid Services (CMS) issued a crucial payment system rule that proposes updated rates and regulatory policies for inpatient hospitals (including inpatient psychiatric...more

CMS Releases Proposed FFY 2014 IPPS Rule

by Mark A. Stanley | Ober|Kaler on 5/2/2013

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects a net increase in operating payments...more

CMS Issues Proposed Changes to LTCH Payment Rates and Other Payment Policies for Fiscal Year 2014

by Paul Pitts | Reed Smith on 5/2/2013

On April 26, 2013, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed update to the Medicare long-term acute care hospital prospective payment system (“LTCH PPS”) policies and payment rates for fiscal...more

CMS Proposes Additional Incentives to Reduce Medicare Fraud Including Increase to Reward for Reporting Fraud

by King & Spalding on 5/1/2013

On April 24, 2013, CMS issued a proposed rule that would further incentivize Medicare beneficiaries and other individuals to report suspected Medicare fraud under the Medicare Incentive Reward Program. CMS is proposing to...more

Hospitals Prevail in Effort to Include Pennsylvania GA Days in the Medicare DSH Calculation

by Gregory Fliszar, Mark Gallant | Cozen O'Connor on 5/1/2013

Two of Mercy Health System’s hospitals (Nazareth Hospital and the former St. Agnes Medical Center) successfully challenged, before Judge Ludwig of the U.S. District Court for the Eastern District of Pennsylvania, the...more

CMS Aims to Grease the Reporting Wheels for Medicare Fraud and Abuse

by Daniele Capasso, Charles Cohen, Howard Young | Morgan Lewis on 4/30/2013

Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority. On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more

Available Recording of Roundtable on CMS Ruling 1455-R and Proposed Rule on Part B Rebilling Issues

by King & Spalding on 4/22/2013

King & Spalding recently hosted a Roundtable Webinar focused on CMS Ruling 1455-R and Proposed Rule 1455-P. Both of these developments are of great interest to the healthcare industry because they have a significant impact on...more

HHS Extends Sunset Date for Stark Exception and Anti-Kickback Safe Harbor for EHR Donations

by Daniel F. Gottlieb | McDermott Will & Emery on 4/19/2013

The Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services issued proposed rules that would extend the sunset date for the Stark Law exception and the federal Anti-Kickback Statute safe...more

Significant Proposed Changes for Federal Health Care Programs in President’s Fiscal Year 2014 Budget Plan

by Elizabeth K. Isbey, Eric Zimmerman | McDermott Will & Emery on 4/19/2013

On April 10, 2013, President Obama released his budget proposal for fiscal year (FY) 2014 (the Budget). The President reiterated his long-standing goal of reducing the deficit by $4.3 trillion over 10 years and his...more

Court Grants Unexpected Victory to Providers on Medicare DSH Adjustment

by Thomas W. Coons, Mark A. Stanley | Ober|Kaler on 4/18/2013

The United States District Court for the Eastern District of Pennsylvania’s opinion in Nazareth Hosp. v. Sebelius, slip op. no. 10-3513 furnished a surprising victory to two providers that challenged the calculation of the...more

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

by Womble Carlyle Sandridge & Rice, PLLC on 4/17/2013

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

CMS Announces CY 2014 MA and Part D Rates with Change to Growth Rate Estimates

by Jeremy Earl, Anne W. Hance | McDermott Will & Emery on 4/5/2013

The Centers for Medicare & Medicaid Services (CMS) released the announcement of CY 2014 payment rates on April 1, which included its change in position regarding the assumption of the "doc fix" in estimates of Medicare...more

Health Care Reform Update -- April 2, 2013

by Joseph P. Hammang, Alexander Hecht, Kevin M. Kappel, Tom Koutsoumpas, Jeremy Rabinovitz, Robert C. Skinner | Mintz Levin - Health Law on 4/3/2013

In This Issue: Implementation of the Affordable Care Act (ACA); Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

CMS Publishes 2014 Final Call Letter

by Tara Swenson | Mintz Levin - Health Law on 4/2/2013

Yesterday, CMS released its 2014 Final Call Letter for the Medicare Advantage and Medicare Part D programs....more

Payment Adjustments for Low-Volume Hospitals and Medicare-Dependent Hospital Program Extended

by Mark A. Stanley | Ober|Kaler on 3/30/2013

CMS has issued a notice that (1) payment adjustments for certain low-volume hospitals and (2) the Medicare-dependent hospital (MDH) program will be extended through federal fiscal year 2013 (FY 2013). The extension of the...more

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

by Donna Senft | Ober|Kaler on 3/30/2013

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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Medicare › Centers for Medicare & Medicaid Services