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Tax Developments Affecting Health Care Organizations and Investor-Owned Hospital Companies [Video]

Several Treasury regulations, revenue procedures, and other developments have recently been released, which may have important consequences for businesses, including health care organizations. Moreover, changes in regulatory...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

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

Also in the News

MACs to Hold Claims for MPFS Services for Ten Business Days Beginning April 1, 2014 – According to Medicare Learning Network Connects eNews, pending the outcome of the SGR Doc Fix legislation (discussed in more detail in...more

MedPAC Releases Annual Report on Medicare Payments

The Medicare Payment Advisory Commission (MedPAC) recently submitted its annual report on Medicare payments to Congress. The report analyzes Medicare payment policy and makes payment update recommendations relating to...more

CMS Extends Deadline for Low-Volume Hospitals and the Medicare-Dependent Hospital Program

On March 14, 2014, CMS released an interim final rule implementing a six-month extension of the low-volume payment adjustment and Medicare-Dependent Hospital (MDH) program under the inpatient prospective payment system (IPPS)...more

OIG Targets Integrated Hospital Systems With Recommended Changes to Medicare’s 3-Day DRG Payment Window

On February 19, 2014, the Office of the Inspector General of the United States Department of Health and Human Services (“OIG”) released a report recommending two changes in the Medicare Diagnosis Related Group (“DRG”)...more

OIG Approves Medigap Policy Contracts with Preferred Hospital Networks

On February 20, the U.S. Department of Health & Human Services, Office of the Inspector General (OIG) released Advisory Opinion 14-02, concerning the use of preferred hospital networks as part of certain Medicare Supplemental...more

Polsinelli Podcast - Health Care Payment Changes: From Service to Value [Video]

Healthcare is changing for consumers and providers under the Affordable Care Act. Less publicized is the way providers are now being paid and the way they will work together. In this week's Polsinelli "Inside Law," podcast,...more

Hospitals Speak Out Against Sequestration Extension

On Wednesday, February 12, 2014, the U.S. Senate passed legislation that, among other things, would further extend Medicare sequestration by one year (until 2024) in part to avoid a reduction in military pensions. Earlier in...more

2014 OIG Work Plan: Impact of Provider-Based Status on Medicare Billing

The 2014 OIG Work Plan includes the following: Policies and Practices. We will determine the impact of subordinate facilities in hospitals billing Medicare as being hospital based (provider based) and the extent to...more

OIG Scrutiny of Hospital Outpatient Evaluation/Management Claims Billed to Medicare

H.H.S’s Office of Inspector General’s yearly work plan was issued on 31 January 2014, which included numerous new and ongoing reviews and activities by OIG for the coming year. Among the new projects, OIG will review...more

MedPAC Recommends Reduction To Hospital Outpatient Department, LTCH Payment Rates, Increases To Inpatient Acure Care Hospital...

On January 16, the Medicare Payment Advisory Committee (MedPAC) unanimously voted to recommend that Congress direct the Secretary of Health and Human Services to...more

"Incident To" Personnel and Credentials: CMS's New Teeth to Address an Old Problem

Medicare’s “incident to” provision found at 42 U.S.C. § 1395x(s)(2)(A) addresses coverage of services and supplies furnished “incident to a physician’s professional service,” principally in a physician’s office or clinic....more

Health Reform + Related Health Policy News - January 2014, Issue 1

In This Issue: - Top News ..Congress Approves Budget Deal with Short-Term ‘Doc Fix' ..CMS “Two-Midnight” Rule delayed until March 31, 2014 ..Individuals with Canceled Insurance Policies May Apply for...more

Two Midnight Rule Updates and How to Preserve Rights to Challenge Rule

Last month, CMS updated its FAQs related to the two midnight rule. In additional, CMS conducted two recent Open Door Forum Calls related to the new rule. Some of the highlights from the updated FAQs and calls are discussed...more

CMS Announces New Payment Model for Maryland

On January 10, 2014, CMS announced that Maryland is shifting to the “the Maryland All-Payer Model,” a new payment model based on a CMS Innovation Center program that tests payment and delivery models. ...more

MedPAC Vote May Result in a 0.6 Percent Drop in Hospital Payments

News sources are reporting that the Medicare Payment Advisory Commission (MedPAC) voted unanimously on January 16, 2014, to recommend that Congress narrow the differences in what Medicare pays providers depending on where a...more

CMS Announces Modernized Medicare Waiver Program in Maryland

Can hospitals cut costs, increase the quality of care, and improve patient outcomes? The State of Maryland and the Centers for Medicare & Medicaid Services (CMS) challenge hospitals to do just that in a newly announced reform...more

Also in the News

President Obama Signs Pathway for SGR Reform Act of 2013 – On December 26, 2013, President Obama signed the Pathway for SGR Reform Act of 2013 (the “Act”), preventing the scheduled payment reduction for...more

CMS Reports Hospital Readmission Rates Declining Under Affordable Care Act

A recent CMS news release reported that Affordable Care Act reforms are leading to lower hospital readmission rates for Medicare beneficiaries. Hospital readmission can be an indicator of poor care coordination or low-quality...more

Medicare Providers React To New Congressional Budget Deal

A recent Congressional budget deal, the Bipartisan Budget Act of 2013, would exclude hospitals from sequester relief. Medicare provider payment cuts would be extended through 2023, two years longer than the cuts set by the...more

CMS Outpatient and Physician Payment Rules: Don't Miss the Efficient Quality of Care Reform Forest for the Dollar Trees

The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more

CMS Releases CY 2014 Hospital OPPS and ASC Final Rule

CMS has published its Calendar Year (CY) 2014 Final Rule for Medicare policy and payment rates for hospital outpatient prospective payment systems (OPPS) and Ambulatory Surgical Center (ASC) services. This final rule with...more

What Is “Past Quality of Care” in a CON Review?

A recent certificate of need (CON) decision has muddied the waters further on the question of what constitutes past quality of care in a CON review. The case involved the Certificate of Need Section’s (CON Section or Agency)...more

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