Medicare

News & Analysis as of

Health Care Update - August 2015

CMS Releases Final Payment Rules (IPPS, IRF, LTCHs, Hospice, and Psych): At the end of last week, the Centers for Medicare and Medicaid Services (CMS) released a set of final 2016 payment rules affecting acute care hospitals...more

CMS Proposes Amendments to Stark Law

On July 15, 2015, the Centers for Medicare & Medicaid Services (“CMS”) published proposed regulations governing policies and payments made under the 2016 Physician Fee Schedule (the Proposed Rule). Notably, the Proposed Rule...more

CMS Issues FY 2016 IPPS and LTCH Final Rule

On July 31, 2015, CMS issued its final rule to update the fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective...more

OIG Issues Favorable Advisory Opinion of Hospital Leasing Arrangement

Last week, the Office of Inspector General (OIG) for the Department of Health and Human Services published Advisory Opinion 15-10 (Opinion). The Opinion addressed a hospital system’s proposal to lease non-clinician employees...more

CMS Announces One Year Partial ICD-10 Relief for Physicians

By now, everyone knows ICD-10 coding starts October 1, 2015. Starting October 1, 2015, Medicare claims with dates of service after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare...more

CMS Extends Enrollment Moratorium on Home Health Agencies

The Centers for Medicare and Medicaid Services (CMS) announced that it will once again extend the moratorium on the enrollment of new home health agencies, branch locations and subunits in certain metropolitan areas of...more

CMS Proposed Stark Law Revisions

On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed revisions to the regulations implementing the physician self-referral law, or Stark Law. The Stark Law is a key regulatory...more

Key Ingredients of CMS' Proposed Comprehensive Care for Joint Replacement Model

On July 14, 2015, CMS released a proposed rule regarding a new, alternative payment model: the Comprehensive Care for Joint Replacement (CCJR) program. Modeled in large part on the Bundled Payments for Care Improvement (BPCI)...more

After Almost 25 Years--New Long-Term Care Regs: An Impressive and Costly Undertaking

On July 16, 2015, CMS released its long-awaited proposed changes for Medicare/Medicaid participation by long-term care (“LTC”) facilities. The new regulations represent the first comprehensive change to the requirements since...more

Impending Deadline: CMS Issues Proposed Rule Reform for Long Term Care Facilities – Part 3 of 4

On July 16, 2015, the Federal Register published Centers for Medicare and Medicaid Services’ (CMS) proposed rule to reform the requirements for Long Term Care Facilities participating in Medicare and Medicaid. CMS will be...more

Identifying the likely beneficiaries of an emerging biosimilars market

Financial analysts have predicted that over the next five years, biosimilars will be a $10 billion market, so it is understandable why considerable attention and investment is being made in this space. However, while there is...more

4 Ways Medicare and Medicaid Have Changed the Health Care Industry

It’s a bizarre program that is absolutely essential to American healthcare. That is the opinion of Theodore Marmor, professor of public policy at Yale and author of the book, The Politics of Medicare. Whether you agree with...more

The “Cross-Your-Fingers-And-Hope-It-Goes-Away” School of Statutory Interpretation”: Recent D.C. Circuit Opinion Orders HHS To...

On June 12, 2015, the U.S. Court of Appeals for the District of Columbia (the “Court”) issued an opinion questioning the Department of Health & Human Services’ (“HHS”) interpretation of congressional intent when it...more

Also In The News - Health Headlines - July 2015 #4

The Joint Commission Revises Nursing Care Center Requirements, Laboratory Requirements, and Outpatient Record Review Requirements for CAHs – On July 9, 2015, the Joint Commission announced revised requirements, effective...more

Member information accessed through Healthfirst’s online portal during fraud scheme

On July 25, 2015, Healthfirst Inc. notified approximately 5,300 of its members that their information may have been compromised during a criminal fraud scheme perpetrated against it. The fraudulent scheme was discovered by...more

CMS Announces Hospices Invited to Participate in the Medicare Care Choices Model

On July 20, 2015, CMS announced the hospices invited to participate in the Medicare Care Choices Model. Under current Medicare rules, a Medicare beneficiary must forgo curative treatments to receive palliative care provided...more

OIG Approves Lease of Employees to Psych Hospital

On July 28 the Office of Inspector General (OIG) of Health & Human Services gave its blessing to a health system’s lease of employees to a related psychiatric system. Under the arrangement the system would also provide...more

Defrauding Medicare — A Little Help from the Private Sector?

The headline on Medicare last week was astounding — $60 billion (not million) was lost each year to Medicare fraud, large numbers of fraudulent providers were providing fake or bad addresses – meaning locations including...more

Manatt on Health Reform: Weekly Highlights - July 2015 #4

CMS offers a special enrollment period for HealthCare.gov enrollees whose incomes were miscalculated due to system error; California Marketplace announces two new insurers; and Connecticut’s budget reduces eligibility levels...more

Criminal Prosecutions of Health Care Fraud: The Stakes Continue to Rise for Individual Providers

On June 18, 2015, the U.S. Department of Justice (DOJ), in collaboration with the U.S. Department of Health and Human Services (HHS), announced criminal charges against 243 individuals located in 14 states for various health...more

Physician Compensation Arrangements Under The Microscope

On June 9, 2015, the United States Department of Health and Human Services Office of Inspector General (OIG) issued a Fraud Alert titled, "Physician Compensation Arrangements May Result in Significant Liability," focusing on...more

CMS Proposes Sweeping Changes for Nursing Home Oversight

On July 16, 2015, the Center for Medicare and Medicaid Services (“CMS”) published a Proposed Rule with new standards that will have a sweeping effect on the long-term care industry. This new Rule is the first comprehensive...more

Affirming the Need to Fix the Medicare Appeals Backlog: The AFIRM Act of 2015

If you are one of the many health care providers wanting to appeal a Medicare contractor’s reimbursement decision, you may need to be prepared for a long wait. Over the last few years, the backlog of appeals to the...more

Health Care Update - July 2015 #3

ACA Repeal Votes Continue: As part of a rare Senate Sunday session to consider a bill to replenish the highway trust fund for six years, Majority Leader Mitch McConnell (R-KY) brought up an amendment to repeal the ACA—in...more

For-Profit PACE Programs: Harbinger of the Future?

The Program of All-Inclusive Care for the Elderly (PACE) is a benefit program provided by the federal government through the Centers for Medicare & Medicaid Services (CMS), geared toward the care of frail, elderly...more

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