Site neutral payment proposals are currently a key topic among policymakers. This +Insight explores how Medicare fee-for-service (FFS) site-of-service patterns vary across states and metropolitan statistical areas (MSAs). Our...more
Introduction- Site neutral payment proposals may affect access differently across patient populations. In this +Insight, we focus on how site-of-service patterns for drug administration services, which both the Medicare...more
The Centers for Medicare & Medicaid Services (CMS) released a final rule on Nov. 2, 2023, detailing how the agency will remedy underpayments from 2018 to 2022 for drugs acquired via the 340B Drug Pricing Program. The final...more
The Centers for Medicare & Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System: Remedy for 340B-Acquired Drugs Purchased in Cost Years 2018-2022 Proposed Rule on July 7, 2023. CMS has published...more
The Centers for Medicare & Medicaid Services (CMS or Agency) on April 10, 2023, published its annual proposed rule for the federal fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital...more
In its March 2023 report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended adjusting the fee-for-service (FFS) base payment rate for acute care hospitals in 2024 by an amount equaling the current...more
The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions. This performance program penalizes hospitals up to three percent of...more
Cardiology procedures in the ambulatory surgery center (“ASC”) setting are growing rapidly. According to MedPAC’s March 2021 report to Congress, there were 88 single-specialty cardiology ASCs billing Medicare in 2019 (the...more
Report on Medicare Compliance 30, no. 11 (March 22, 2021) - University Medical Center of Southern Nevada has agreed to pay $128,820 in a civil monetary penalty settlement that stemmed from a self-disclosure. According to...more
On July 17, 2020, in a blow to health care providers, the U.S. Court of Appeals for the D.C. Circuit overturned a lower court’s more favorable ruling and held that the Department of Health and Human Services (“HHS”)...more
Four separate government releases coming over a three-week period have once again highlighted the intense interest in the 340B drug pricing program, with a federal agency and two government watchdog groups issuing guidance...more
Investor Interest in Health IT Expected to Remain Strong in 2020 - After three years of strong growth in healthcare technology funding, investor interest in the space has not abated....more
In a long anticipated regulation, the Centers for Medicare & Medicaid Services (CMS) recently updated the hospital, critical access hospital (CAH) and home health agency (HHA) conditions of participation related to the...more
CMS took another step in its campaign to impose "site neutrality" on hospital outpatient payments with its recently published final Medicare hospital Outpatient Prospective Payment System (OPPS) rule for CY 2019. The final...more
As the Trump Administration moves forward with proposed policy changes to address high drug prices, a common theme is emerging: a number of the proposals have the potential to reduce Medicare reimbursement to hospitals and...more
On April 5, the Medicare Payment Advisory Commission (MedPAC) issued a unanimous recommendation to decrease some urban outpatient hospitals’ Medicare payments, while increasing rural hospital payments to improve emergency...more
In public meetings held on January 11-12, 2018, Medicare Payment Advisory Commission (MedPAC) members voted to recommend that Congress maintain Medicare’s current updates for payments to providers for acute care hospital...more
In December 2017, the Medicare Payment Advisory Commission (MedPAC) issued a report to Congress analyzing the impact of physician supervision requirements in critical access hospitals (CAHs) and small rural hospitals. ...more
The Situation: A Final Rule published by the Centers for Medicare & Medicaid Services carries a provision that reduces reimbursement for most 340B Program drugs dispensed by disproportionate share hospitals and rural referral...more
Mark Miller, MedPAC’s Executive Director, testified before the House Ways and Means Committee last week to discuss MedPAC’s Annual Report to Congress, Medicare Payment Policy, which was released March 15, 2017. ...more
On December 7, 2016, the US Congress enacted the 21st Century Cures Act, substantial legislation intended to accelerate “discovery, development and delivery” of medical therapies by encouraging biomedical research investment,...more
In Depth - On June 16, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) posted a report examining the Centers for Medicare & Medicaid Services’ (CMS’s) oversight of billing by...more
This is the second of three alerts discussing the mid-year update to the Fiscal Year 2016 Work Plan issued by the Office of Inspector General (OIG). In the first alert we discussed the top management performance challenges...more
McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more
On March 15, 2016, the Medicare Payment Advisory Commission (MedPAC) released its latest report to Congress that included 340B Implications for Medicare Part B Drugs along with a quick fact sheet regarding the report. Key...more