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Three Factors Affecting the Mid-Level Practitioner Workforce, Part Two

In the last post, the subjects of collaborative agreements and autonomy were discussed in relation to how they affect mid-level practitioners. Today’s post now turns to how HRSA designation and limited services clinics will...more

Health Headlines: Also in the News - January 2015 #3

ALSO IN THE NEWS - HHS Publishes Goals on Alternative Payment Models with Continued Focus on Quality – In its continued efforts to base Medicare payments on quality over quantity, this morning HHS made public its goal...more

HHS Aims to Tie Most Medicare Reimbursements To Quality By 2018

Health and Human Services (HHS) Secretary Sylvia M. Burwell announced on January 26, 2015, specific goals and a timeline for shifting Medicare reimbursements from the traditional fee-for-service (FFS) model, to a quality or...more

Court Allows Home Care Group to Challenge Medicare “Narrative Requirement” Regulation

On January 9, 2015, Judge Christopher P. Cooper, United States District Judge for the District of Columbia, issued a decision denying the government’s motion to dismiss the complaint in National Association for Home Care &...more

Revision of Overpayment Interest Rate

On January 21, 2015, a new interest rate of 10.5% for Medicare overpayments and underpayments became effective. The new rate is lower than the previous rate of 10.75% that has been in place since October 20, 2014....more

OIG Report Recommends Reforms to Reduce Hospice Incentives to Provide Care in Assisted Living Facilities

On January 14, 2015, OIG published a report that analyzes Medicare payments for hospice care in assisted living facilities (ALFs). OIG concluded that CMS should implement measures to reform Medicare payments to hospices,...more

No Judicial Relief to the ALJ Waiting Game — Yet

In May 2014, the American Hospital Association filed suit against the United States Department of Health and Human Services seeking to compel Administrative Law Judges (ALJs) to comply with applicable statutory deadlines for...more

HHS Sets Ambitious Goals for Medicare Quality/Value-Based Purchasing, Alternative Payment Models

Today HHS Secretary Sylvia M. Burwell announced ambitious plans to move from “volume to value in Medicare payments” by accelerating the share of Medicare fee-for-service (FFS) payments that are tied to quality and value and...more

CMS Announces Goals and Timeline for Shift to Value-Based Medicare Payments

On January 26, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a news release reporting Health & Human Services (HHS) Secretary Sylvia Burwell’s announcement earlier in the day of measurable goals and a...more

HHS Ups The Ante: Announces Percentages And Time Frames On Goals For Medicare Pay-For-Value Efforts

On January 26, 2015, the Secretary of the United States Department of Health and Human Services (“HHS”), Sylvia Mathews Burwell, announced two important goals for the Department...more

Healthcare Compliance Programs: Stepping Up the Game

The Affordable Care Act was enacted in 2010 – can anyone remember back that far? The ACA required Medicare and Medicaid providers to have an ethics and compliance program....more

Manatt on Health Reform: Weekly Highlights #4

This week, the IRS announces relief for some taxpayers who received excess advanced premium tax credits; Indiana and Arkansas make major announcements on Medicaid expansion and Iowa’s Governor announces a shift towards...more

Second Circuit Revives Medicare Beneficiaries’ Observation Status Suit

On January 22, 2015, the U.S. Court of Appeals for the Second Circuit reversed a decision by the U.S. District Court for the District of Connecticut dismissing a lawsuit by Medicare beneficiaries alleging deprivation of due...more

Summary Chart Of Proposed Amendments To 42 C.F.R. Part 425 Governing The Medicare Shared Savings Program

Mintz Levin has prepared a chart of the proposed amendments to 42 C.F.R. Part 425 governing the Medicare Shared Savings Program. This chart provides a summary of each proposed amendment and its potential impact....more

OIG Defends Its Hospital Compliance Reviews in Response to AHA Criticism

The Office of the Inspector General for the Department of Health and Human Services(“OIG”) responded to concerns expressed by the American Hospital Association (“AHA”) regarding the OIG’s hospital compliance reviews,...more

CMS Announces Enforcement of EHR Payment Adjustments in 2015

On December 17, 2014, the Centers for Medicare and Medicaid Services ("CMS") announced that there would be reductions in Medicare reimbursement for health care providers who do not meet the CMS electronic health record...more

Catching Up on the False Claims Act

From a corporate risk perspective, if your company is in the financial industry, healthcare, or defense industry, your greatest legal and compliance risk has to be the False Claims Act....more

Healthcare Fraud: Aggressive Enforcement Strategies

This week I am focusing on the persistent problem of healthcare fraud. For healthcare providers, the challenge of compliance and avoiding enforcement risks is particularly difficult. ...more

OIG Questions Incentives for Hospice Care in Assisted Living Facilities

Today the OIG issued a report examining the growing use of Medicare hospice care in the assisted living facility (ALF) setting. According to the OIG, Medicare payments for hospice care in ALFs grew by more than 119% from 2007...more

Medicare DMEPOS Competitive Bidding Window is Now Open

The bidding window is now open for the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program Round 2 Recompete and the National Mail-Order Recompete for diabetic testing...more

OIG Recommends Greater Scrutiny for Hospice Services in ALFs

The OIG’s recently released study examining Medicare hospice claims from 2007 to 2012 calls for targeted reviews of hospices that receive a high proportion of their payments for care in assisted living facilities....more

MedPAC Voices Concerns about Growing Volume, Burden of Medicare Quality Measures

In December 2014, CMS released a 329-page list of quality measures under consideration for the Medicare program. In a January 13, 2015 comment letter, MedPAC observes that volume of measures under consideration “reinforces...more

First Circuit Reaffirms FCA’s “First-to-File” Bar as a Broad Jurisdictional Limit

In early December 2014, the United States Court of Appeals for the First Circuit reaffirmed that circuit’s broad interpretation of the False Claims Act’s “first-to-file” bar, 31 U.S.C. § 3730(b)(5), in United States ex rel....more

Stage 3 EHR Incentive Program, Health IT Certification Rules at OMB

HHS has sent to the White House Office of Management and Budget (OMB) for final regulatory clearance a proposed rule on Stage 3 meaningful use criteria for the Medicare and Medicaid Electronic Health Record (EHR) Incentive...more

CMS Publishes Medicare QIO Criteria

CMS has published notices setting forth the criteria it will use to evaluate the effectiveness and efficiency of Quality Innovation Network (QIN) and Beneficiary and Family Centered Care (BFCC) Quality Improvement...more

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