Medicare Centers for Medicare & Medicaid Services

News & Analysis as of

Fifth Circuit Upholds CMS’s Critical Access Hospital Guidelines

CMS’s definitions of “primary roads” and “secondary roads,” as used to determine what constitutes a critical access hospital, withstood another court challenge last week....more

Direct Primary Care: Getting Calls from Patients While Avoiding Calls from Law Enforcement

For providers interested in simplifying the provider-patient relationship, one option is direct primary care. Ironically, though, simplification can be complicated, particularly when the government is involved. One of the...more

2018 “Next Generation” Accountable Care Organization (ACO) Models

CMS is soliciting applications for 2018 Next Generation ACOs, an Innovation Center initiative intended to promote Medicare quality improvement and care coordination. Letters of intent are due May 4, 2017. ...more

Shorts On Long Term Care March 2017 - News for the NC LTC Community

Thursdays with Mama - Life has a rhythm, a symmetry, a meter, a metric. It’s rarely smooth or perfect. It’s knots and knuckles, bumps and bruises. It’s rough and tumble. It sings its own song in its own...more

CMS Issues Instructions to Hospitals Regarding the Implementation of Ruling 1498-R2

In April 2015, CMS issued Ruling 1498-R2 addressing the calculation of the Medicare fraction of the disproportionate share hospital (DSH) adjustment for patient discharges prior to October 1, 2004. CMS has now issued...more

Recent Changes to Medicare “Incident To” Billing Rules

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more

Medicare Mandatory Bundled Payments Rule: Minor Aspects Delayed, Others On-Schedule for July Implementation

In a move the Centers for Medicare & Medicaid Services cites as a reaction to President Donald Trump's regulatory freeze, CMS announced that implementation of certain minor aspects of the final rule expanding Medicare...more

House Republicans Release Obamacare Repeal and Replace Policy Brief; Senate Finance Committee Holds Hearing on Verma CMS...

On February 16, 2017, House Republicans released a policy brief on how to repeal and replace the Affordable Care Act (ACA). The brief builds upon the ideas outlined in the 2016 “A Better Way” proposal and promises action on...more

Can medical residents admit hospital inpatients?

In federal fiscal year 2014, concurrently with the implementation of the Two Midnight Rule, CMS adopted a new regulation (the "Admissions Regulation") making the inpatient admission order an express condition of Medicare...more

Chiropractic Service Overpayment for Lack of Medical Necessity

Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic...more

New Medicare Conditional Payment Case: Federal Court Requires CMS To Perform Surgery On Its Primary Plan Reimbursement Demands

Doctors often treat Medicare beneficiaries for accident related injuries (for which a “primary” auto or workers’ compensation carrier must reimburse Medicare) and unrelated maladies at the same visit. Billing for the visit...more

Trump Administration Takes First Steps to Support Exchanges, but Key Questions Remain

In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing deadlines and published a...more

Capitol Hill Healthcare Update

Meeting privately with Senate Republicans to discuss next steps on the ACA was among the first actions taken last week by the new Secretary of the U.S. Department of Health and Human Services Tom Price. But GOP senators left...more

Medicare & Medicaid Remain Vulnerable to Fraud and Abuse, GAO Warns

The Government Accountability Office (GAO) is out with the latest installment of its “High-Risk Series,” which identifies federal programs “that are especially vulnerable to waste, fraud, abuse, and mismanagement, or that...more

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against...more

Change on the Horizon for Decades-Old Home Health Agency Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) has issued final regulations (CMS-3819-F) that will make substantial changes to the Medicare home health agency Conditions of Participation (CoPs). These sweeping changes...more

What's "Hidden" in the 21st Century Cures Act for Health Care Entities

The 21st Century Cures Act (Cures) was signed into law December 13, 2016. While the primary focus of the 996-page Act centered on biomedical innovation, several components of Cures have significant implications for health...more

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

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

Health Care E-Note - Februaury 2017

Ransomware: A Reportable Breach? In the past several years, a huge increase has occurred in the number of electronic attacks in the United States using ransomware, a form of malware that targets and encrypts critical...more

HHS Finalizes Appeals Backlog Rule in Wake of Judicial Order

The U.S. Department of Health and Human Services (HHS) released a Final Rule aimed at reducing and eventually eliminating the backlog of more than 650,000 claims currently awaiting adjudication by an administrative law judge...more

Trump Administration Issues Proposed Health Insurance Market Stabilization Rule: Will It Be Enough to Stabilize Exchange...

On 15 February 2017, the Centers for Medicare & Medicaid Services (CMS) took a step toward addressing concerns about the stability of the individual and small group health insurance markets by proposing a modicum of...more

Home Health Agency Final Conditions of Participation Revisions Released by CMS

The Center for Medicare and Medicaid Services has issued a final rule that revises and modernizes the Conditions of Participation (COP) for Home Health Agencies. The Final Rule can be found in its entirety at: Final Home...more

CMS Grants Eleventh Hour Extension for Attesting to Meaningful Use

Providers participating in the Medicare Electronic Health Record (EHR) Incentive Program now have an additional thirteen days to register and attest to meeting the meaningful use requirements for 2016. The Centers for...more

CMS Provides Sneak Preview of Future DMEPOS Competitive Bidding Plans Before Retracting Announcement

One week after unveiling the next round of Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding, the Centers for Medicare & Medicaid Services (CMS) has announced a “temporary...more

Medicare Advantage Draft Call Letter Addresses Encounter Data, Star Ratings

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released proposed updates to the Medicare Advantage (MA) and Part D programs through the CY 2018 Advance Notice and Draft Call Letter. Despite largely...more

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