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Health Update

Assessing the Medicare Shared Savings Program: Diverse Participants, Diverse Results - Rising healthcare costs and declining reimbursements have placed immense pressure on providers and health systems to manage the...more

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

Health Headlines: Also in the News

340B “Mega-Reg” Under Review by OMB – The Health Resources and Service Administration (HRSA), Office of Pharmacy Affairs sent the long-awaited 340B Proposed Rule to the Office of Budget and Management Affairs (OMB) last week...more

CMS Proposes Adoption of Updated Life Safety Code

Wednesday morning, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding adopting the 2012 edition of the Life Safety Code (LSC). CMS states the updated code contains new provisions that are...more

CMS Issues Medicare Advantage And Part D Final Call Letter For 2015

The Medicare Advantage and Part D Final Call Letter announces requirements for the 2015 contract year, including changes to Part C and Part D star ratings and how CMS will evaluate Part D plan structures submitted for the...more

CMS Releases Rate Announcement and Final Call Letter for Medicare Advantage and Part D Programs

On April 7, 2014, CMS issued the 2015 rate announcement and final call letter for the Medicare Advantage and Part D programs. Notably, CMS reversed planned rate cuts to Medicare Advantage plans, and is instead replacing those...more

Don't Be Left On The Sidelines: CMS Is Seeking Applications For A New Hospice Demonstration Program

Currently, Medicare patients that wish to receive palliative hospice care have a tough choice to make—forgo any curative treatment or incur all hospice care costs. This could change, however, with the recent launch of CMS's...more

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

If It’s Broken, Fix It (At Least Temporarily): New “Doc Fix” Law Prevents Automatic Medicare Pay Cuts to Physicians

Were you worried that your physician pay rate would plummet come March 31 due to Medicare’s sustainable growth rate (“SGR”) formula? You can stop pulling out your hair, at least until next year. On April 1, 2014, President...more

Also in the News

CMS to Provide Public Access to Physician Payment Data – In a recent post on its official blog, CMS announced it will provide “unprecedented access” to information on services delivered by individual physicians and certain...more

CMS Releases Physician Medicare Billing Data

The U.S. Department of Health and Human Services (HHS) announced on April 9th a “historic” release of Medicare payment data to provide consumers with “unprecedented transparency on the medical services physicians provide and...more

Department of Health and Human Services to Release Medicare System Data

Last week, the Department of Health and Human Services (HHS) announced that they will begin to publicly release Medicare system data, including payment and utilization rates, for the 880,000 physicians currently participating...more

Health Law Wire: Physician Medicare Revalidation Notice

On January 29, 2014, the National Government Services, Inc. announced that it would begin mailing out revalidation notices (“Notice”) to physicians enrolled in the Medicare program sometime in the next (12) months. Physicians...more

CMS Issues Final Call Letter for 2015

Earlier this week, CMS announced in its Final Call Letter that Medicare Advantage rates would rise an average of 0.4 percent in 2015, instead of falling 1.9 percent as proposed in February. CMS’s shift in course may stem...more

I’ll Be Watching You: Medicare Billing Info on over 880,000 Providers Released by CMS to Improve Transparency

Every payment you take, every claim you make, someone will be watching you. No, we don’t mean Sting. We mean all the consumers and businesses that will have greater access to physician billing information now because today...more

D.C. Circuit Requires Greater Disclosure of Changes in Medicare Regulations

The rulemaking process often accommodates a variety of interests, including the preference of regulatory agencies to maintain some flexibility and the rights of interested parties to participate in the regulatory process. On...more

ACA’s Deductible Limits for Small Groups Repealed

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. The primary purpose of the law is to provide a one-year delay of a 24% reduction in payment rates for physicians who participate...more

Number 17: Congress Patches the SGR Yet Again

For the 17th time since the Sustainable Growth Rate (SGR) became law as part of the Balanced Budget Act of 1997, last week the Congress passed a short-term “patch” to prevent scheduled cuts from going into effect for...more

Do you understand the new Medicare surtax?

Here are six simple rules for individual taxpayers to remember - Beginning with tax year 2013, certain individuals, trusts, and estates may be subject to a 3.8% surtax under Section 1411 of the Internal Revenue Code....more

Enforcement of the Two-Midnight Rule Delayed Again

Last week President Obama signed into law a measure to extend Medicare physician pay rates for one year and to extend the enforcement delay of the “Two-Midnight” rule through March 2015. Medicare Recovery Audit Contractors...more

D.C. Circuit Rules that the Medicare DSH Rule Requiring the Inclusion of Part C Days in the “Medicare Fraction” in the DSH Formula...

Last week, the United States Court of Appeals for the District of Columbia Circuit upheld the ruling of a federal district court vacating HHS’s 2004 Disproportionate Share Hospital (“DSH”) rule regarding Part C days. The...more

ICD-10 Delayed Again

While I didn’t intend for the theme of my Health Care Law Today posts to be delays, there is no shortage of postponements to write about lately. The House and Senate passed H.R. 4302, Protecting Access to Medicare Act of...more

Provisions of Interest to Labs in the Protecting Access to Medicare Act of 2014

The Protecting Access to Medicare Act of 2014 (HR 4302), signed by President Obama yesterday, contains a number of provisions that are important to clinical laboratories, and they include...more

CMS Advised to Follow Private Sector Practices to Improve Physician Feedback Reports

On March 26, 2014, the Government Accountability Office (GAO) released its report regarding the private sector’s physician feedback reporting practices and how implementation of such practices could improve CMS’s own reports...more

Manatt on Medicaid: New Hampshire Elects to Expand Medicaid Using Private Plans

Last week, New Hampshire’s governor signed a law (Senate Bill 413-FN-A) that will expand Medicaid to adults with incomes up to 133 percent of the federal poverty line. The law is expected to result in some 50,000 New...more

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