News & Analysis as of

Reporting Requirements Health Care Providers

Federal Government to Target False EHR Incentive Payments

by Barley Snyder on

While health care reform remains bogged down, the federal government’s efforts to curtail fraud, waste and abuse in its health care programs fervently continues. Most recently, the U.S. Department of Health and Human...more

Sixth Circuit: Technical Physician Signature Deficiencies not "Material" to Reimbursement Claims

by Jones Day on

The District Court for the Middle District of Tennessee held on June 22, 2017, that the timing requirements related to a physician's certification of need for home health services were not "material" to the Centers for...more

Healthcare Data: Are You Required to Report a Ransomware Attack?

by Bennett Jones LLP on

If you are a healthcare data custodian that is subject to a ransomware attack, you may be required to report the incident to regulators and to those individuals whose information was subject to the attack....more

AGG Food and Drug Newsletter - May 2017

by Arnall Golden Gregory LLP on

Arnall Golden Gregory LLP's Food and Drug Newsletter is a monthly update of legal and regulatory issues that affect the FDA-regulated community, including regular updates on legislative initiatives from AGG’s Washington, DC...more

Revocation of Enrollment in the Medicare Program- A Powerful Weapon in Medicare’s Arsenal

by Burr & Forman on

In 2014, CMS issued a final rule related to 42 CFR 424.535, which gave CMS expanded authority to impose penalties on providers. Although the rule is several years old, the first version published in 2006, the rule has been...more

French sunshine regulations: the puzzle now completed and in force

by Hogan Lovells on

The French sunshine regulations require industry to report certain agreements along with the fees and other benefits provided to various stakeholders in the healthcare sector. ...more

Florida Supreme Court Rejects PSQIA Preemption of Florida Constitution

On January 31, 2017, the Florida Supreme Court held that adverse medical incident reports produced in accordance with Florida law cannot constitute confidential and privileged patient safety work product (PSWP) under the...more

TortSource: Ransomware: A Reportable Breach?

by Burr & Forman on

In the past several years, a huge increase has occurred in the number of electronic attacks in the United States using ransomware, a form of malware that targets and encrypts critical data and systems for the purpose of...more

Burr Alert: New Requirements of Participation for Skilled Nursing Facilities

by Burr & Forman on

On October 4, 2016, The Centers for Medicare and Medicaid Services (“CMS”) released the final rules regarding the requirements of participation for skilled nursing facilities. One of the most significant changes to the...more

Final Rule Implements Quality Payment Program under MACRA

by Baker Ober Health Law on

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

Catching Up With the Times: CMS Reforms Long-Term Care Facility Requirements Part III

by Polsinelli on

On October 4, the Centers for Medicare and Medicaid Services (CMS) published the biggest overhaul to federal long-term care regulations since 1991, and impacted facilities can immediately take steps to ensure they’re prepared...more

Sixth Circuit Holds That Michigan Health Insurance Claims Assessment Act Falls Outside of ERISA’s Preemptive Reach

by K&L Gates LLP on

Whether state common law claims are preempted by the Employee Retirement Income Security Act of 1974 (ERISA) is a common issue in reimbursement disputes involving health care providers and insurance companies. In cases when...more

CMS Proposes OPPS Reimbursement Adjustments: What Hospital Outpatient Providers Need to Know

by Polsinelli on

In early July, the Centers for Medicare & Medicaid Services (CMS) proposed Hospital Outpatient Prospective Payment System (OPPS) reimbursement rule changes that will impact reimbursement payment amounts and requirements for...more

CMS Finalizes Plan to Expand Medicare/Private Claims Data Available for Care Improvement

by Reed Smith on

CMS has published a final rule to allow organizations approved as “qualified entities” to confidentially share or sell analyses of Medicare and private-sector claims data to providers, employers, and other groups who can use...more

New Proposed Legislation: Doctors Must Report Med Device-Related Deaths & Injuries

by Knobbe Martens on

Representatives Mike Fitzpatrick (R-PA) and Louise Slaughter (D-NY) announced plans to propose the Medical Device Guardians Act of 2016. According to a press release from Rep. Fitzpatrick, the Act is “a package of bills aimed...more

CMS Finalizes Changes to Medicare Clinical Lab Test Payment Policy, Pushes Back Effective Date to 2018

by Reed Smith on

On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) is publishing a major final rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts, as required by...more

HHS guidance seeks to clarify scope of PSQIA

On May 24, 2016, the Department of Health & Human Services (HHS) issued guidance (Guidance) to health care providers and patient safety organizations (PSOs) in an attempt to clarify the definition of patient safety work...more

Health Care Group News: Part Two: The Rest of SB 351 (Now Public Act 16-95)

by Murtha Cullina on

While Senate Bill 351, now enacted as Public Act 16-95 (the "Act"), received attention for the limits it placed on physician non-compete provisions, numerous other provisions of the Act are worth highlighting. These...more

Tennessee Enacts Changes to Data Breach Statute

Businesses in the State of Tennessee should take note of several significant changes to Tennessee's data breach statute that take effect for data breaches occurring on or after July 1, 2016. Currently, Tennessee Code...more

CMS Update to Medicaid Managed Care Regulations Should Prompt Significant Change

by Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (“CMS”) has released the final version of its much anticipated revisions to the regulations governing Medicaid managed care (the “Final Rule”). First proposed in May 2015, the...more

CMS Finalizes Rule on Reporting and Returning Medicare Overpayments

The Affordable Care Act (sometimes referred to as Obamacare) included a requirement for providers to report and return all Medicare and Medicaid overpayments within 60 days of identification. Although this requirement has...more

Next Steps: Helping Your Organization Implement the New Medicare Overpayment Rule - Part II

On February 12, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule that explains the requirements for providers and suppliers reporting and returning overpayments under Medicare Parts A & B (the...more

Next Steps: Helping Your Organization Implement the New Medicare Overpayment Rule - Part I

On February 12, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule that explains the requirements for providers and suppliers reporting and returning overpayments under Medicare Parts A & B (the...more

CMS Finalizes 60-Day Overpayment Rule

by LeClairRyan on

The federal government has clearly established that failure to report and refund an identified overpayment within 60 days of identification could trigger False Claims Act (FCA) liability. When an overpayment has been...more

CMS Call on 2016 PQRS Reporting & Avoiding 2018 Negative Payment Adjustments

by Reed Smith on

On April 21, 2016, CMS is hosting a provider call on the 2016 Physician Quality Reporting System (PQRS), including how eligible professionals and group practices can satisfactorily participate and report in order to avoid the...more

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