Reimbursements

News & Analysis as of

CMS Publishes Proposed 2015 OPPS and ASC Payment Rule

On July 3, 2014, CMS posted the proposed CY 2015 outpatient perspective payment system (OPPS) and Ambulatory Surgical Center (ASC) payment rule, which was subsequently published in the Federal Register on July 14, 2014 [PDF]....more

Software Glitch Sparks FCA Suit Against Hospitals for Late Repayment of Medicaid Reimbursements

On June 27, the New York Attorney General’s Office and the U. S. Attorney’s Office for the Southern District of New York intervened in a qui tam suit against Continuum Health Partners, Inc., Beth Israel Medical Center and St....more

AMA Issues Telemedicine Guidelines

On June 11, 2014, the American Medical Association (AMA) released a new set of telemedicine principles, which emerged from its policy report addressing “Coverage and Payment for Telemedicine.” The AMA report details the...more

The IRS Says (Again) That Certain Employer Payment Plans Won’t Fly

The IRS recently issued two new Q&As to underscore that arrangements allowing employers to reimburse employees on a pre-tax basis for premiums used to purchase individual health coverage, either inside or outside of a public...more

Friday Afternoon Smackdown – The SEC v. The House Of Representatives

On Friday, June 20, 2014, the Securities and Exchange Commission filed an action against the Committee on Ways and Means of the U.S. House of Representatives and congressional staffer Brian Sutter seeking enforcement of...more

EU consumers’ right of withdrawal: new conditions to apply for distance selling and off?premises contracts on 13 June 2014

The new Directive n° 2011/83/EC of 25 October 2011 on consumer rights (the “new Directive on Consumers Rights”) provides a harmonized 14-day right for consumers to cancel their orders and to be reimbursed. These new...more

Employer Reimbursements For Health Insurance Policy Premiums–Care Needed

Employers who reimburse employees on a pre-tax basis for premiums the employees pay on their own individual health insurance policies (whether under an Obamacare Exchange or otherwise) are at risk for a $100 per day per...more

Healthcare Providers Face Increasing Financial Pressure and Bankruptcy Risk

The health of the healthcare industry can be summarized as follows: as go federal reimbursement rates, so goes the financial viability of healthcare providers, whether hospitals, nursing homes or medical practices. These...more

Federal and California State FCA Claims Against NEMS Survive Summary Judgment

On May 13, 2014, a California federal court substantially denied summary judgment motions in United States ex rel. Trinh (No. 4:10-cv-01904 [consolidating Nos. C 10-1904 CW, C 12-2895 CW, C 10-2433 CW, C 10-4605 CW] [N.D....more

IRS Issues Guidance Effectively Prohibiting Employers From Reimbursing Employees For Individual Health Insurance Premiums

The IRS’ reasoning is that such reimbursement arrangements, often referred to as “employer payment plans” are “group health plans.” All group health plans must meet the Affordable Care Act’s “market reform” requirements, such...more

Provider Reimbursement Review Board Imposes New Requirements for Providers with Pending Medicaid Eligible Days Appeals

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers with pending appeals before the Provider Reimbursement Review Board (PRRB) of a new sixty-day submission requirement for the Medicaid eligible...more

Gotham Insurance V. Warren E&P Answers Age-Old Question

In Gotham Insurance Co. v. Warren E&P Inc., the Texas Supreme Court recently addressed an age-old and often-asked question: Can an insurer recoup money paid to its insured when it later learns it overpaid? The answer:...more

Justices Mulling Whom Insurers Can Sue for Reimbursement

Insurance companies hate paying to defend claims they believe may not be covered - especially where the defense fees are significant. But when they do pay for the defense of claims they feel they should not have to...more

HHS Proposes Extension of Deadline for EHR Compliance

According to the federal government, over 370,000 providers have participated in the Medicare and Medicaid Electronic Health Record ("EHR") incentive program since its inception in 2011. However, providers nationwide continue...more

Freddie Mac Updates Foreclosure, Expense Reimbursement Requirements

On May 15, Freddie Mac issued Bulletin 2014-09, which updates foreclosure requirements to (i) permit servicers to begin utilizing the New York Foreclosure Inquest Program as an alternative foreclosure process to accelerate...more

US Appeals Court Lights A Match On Issue Of Government Reimbursement For WWII Aviation Gasoline Waste Disposal

Two weeks ago the United States Court of Appeals, Federal Circuit re-opened the door to recovery of Comprehensive Environmental Response, Compensation, and Liability Act ("CERCLA") cleanup costs under contractual provisions...more

Meals and Lodging

The Nevada Division of Industrial Relations has determined that meals and lodging for attending physician appointments will be paid at per diem reimbursement rates set by the U.S. General Services Administration...more

The Check’s in the Mail - Who Is Responsible for Payment in a Delegated-Network System?

In today’s healthcare system, reimbursement issues involve not only prompt pay statutory provisions but also various risk-shifting arrangements included in a delegated-network system of managed care. When the insolvency of...more

Federal Appeals Court Holds That H&R Block Does Not Have To Pay Trainees For Mandatory Pre-Hire Continuing Professional Education...

On May 2, 2014, the U.S. Court of Appeals for the Eighth Circuit held that time spent by accountants attending a continuing professional education training course was not compensable because the accountants were not employed...more

CMS Announces Proposed SNF Reimbursement Rates for FY2015

On May 1, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would include payment and policy changes for skilled nursing facilities (SNFs) (Proposed SNF Rule). The Proposed SNF Rule would...more

Paying Employees For Travel Time

Both the state and federal wage and hour laws have provisions addressing the question of when time spent traveling by a non-exempt employee is compensable. A new decision of the Connecticut Supreme Court in the case of...more

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers

As part of the Affordable Care Act, Congress outlined the process for providers to return Medicare and Medicaid overpayments. In 2012, CMS proposed the 60-day Refund Rule, as it is commonly known, requiring Medicare providers...more

Quality Control Is Job 1

In January, U.S. Magistrate Judge Paul S. Grewal sanctioned Samsung and its law firm for a series of violations involving the disclosure of a document containing confidential information in contravention of the court’s...more

High Court Employee Benefits Cases: A Review and Look Ahead

Having settled into the new year, we reflect on decisions from the U.S. Supreme Court in 2013 that are likely to have a significant impact in the world of pension and welfare employee benefits and, in some cases, already have...more

Missouri Supreme Court Holds Federal Act Does Not Preempt Missouri Law Barring Subrogation Of Personal Injury Claims

In essence overruling a previous opinion from the courts of appeal, the Missouri Supreme Court has held that the Federal Employee Health Benefits Act (“FEHBA”) does not preempt Missouri law prohibiting the subrogation of...more

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