Reporting Requirements Health Care Providers

News & Analysis as of

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

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

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

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)

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

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

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

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

Center for Medicare & Medicaid Services Announces 60-Day Overpayment Rule

The Centers for Medicare & Medicaid Services (CMS) published the Reporting and Returning of Overpayments Final Rule (Final Rule) on February 12, 2016. The Final Rule implements Section 6402(a) of the Affordable Care Act,...more

Fighting Prescription Drug Abuse Gets a Little Easier for Florida Providers, Pharmacists

Pharmacies, dispensing prescribers, and certain healthcare facilities in Florida will soon have an easier time complying with controlled-substance reporting requirements. Florida established its Prescription Drug Monitoring...more

CMS Clarifies 60-Day Reporting Requirements For Medicare Parts A & B

The Centers for Medicare and Medicaid Services (“CMS”) has clarified the reporting requirements and lookback period for overpayments from Medicare Parts A and B in Final Rule 6037 (“Final Rule”), issued by CMS on February 12,...more

House Unanimously Approves Legislation to Remove Terminated Providers from Medicaid, CHIP

The House of Representatives has unanimously approved H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act. The bill, which still awaits Senate consideration, would implement several OIG recommendations to improve...more

CMS Implements Final Rule on Medicare Parts A and B Overpayments

After more than four years since the issuance of its Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) will implement its Final Rule on the reporting and return of Medicare Parts A and B overpayments,...more

CMS Finalizes the 60 Day Overpayment Rule

The Department of Health and Human Services’ (HHS) Center for Medicare and Medicaid Services (CMS) published its final rule on Friday, February 12, 2016. The final rule clarifies two key sections of the often described 60-Day...more

The Deeper Dive: The Final Overpayment Rule

The Centers for Medicare and Medicaid Services (CMS) recently issued its final rule for Reporting and Returning of Overpayments (Final Rule). The Final Rule implements section 1128J(d) of the Social Security Act, which...more

February 2016: The Month of Groundhog Day, Super Bowl 50, Valentine’s Day … and HIPAA Breach Notifications

Feb. 29, 2016, a/k/a Leap Day, is the date by which HIPAA covered entities must notify the U.S. Department of Health and Human Services Office for Civil Rights (OCR) of “small” breaches of unsecured protected health...more

Critical Analysis of CMS’ Final Rule Implementing the Affordable Care Act’s 60-Day "Report and Return" Overpayment Rule

On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) published a long-awaited final rule (Final Rule) implementing the Affordable Care Act’s (ACA’s) statutory requirement that certain overpayments be...more

CMS Finalizes 60-Day Rule Overpayment Regulations

On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) released a final rule (Final Rule) interpreting the application of Section 1128J(d) of the Social Security Act (the 60-Day Rule) to over payments...more

Deadline for reporting 2015 data breaches to OCR quickly approaching

Pursuant to HIPAA/HITECH, covered entities are required to report breaches of unsecured protected health information that occurred in 2015 and affected less than 500 individuals to the Office for Civil Rights no later than 60...more

CMS Announces Final 60-Day Overpayment Rule

The Centers for Medicare & Medicaid Services (CMS) published the Reporting and Returning of Overpayments Final Rule (Final Rule) on February 12, 2016. The Final Rule implements section 6402(a) of the Affordable Care Act which...more

CMS Releases Final Rule on 60-Day Requirement to Report and Return Overpayments

On February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) published its long-awaited final rule (the “Final Rule”) governing the requirement that healthcare providers report and return Medicare overpayments...more

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