News & Analysis as of

CMS Announces CY 2015 Home Health Prospective Payment System Rates

On October 30, 2014, CMS issued a final rule for Medicare Home Health Prospective Payment System (HH PPS) rates for CY 2015. The final rule estimates that Medicare payments to home health agencies (HHAs) in CY 2015 will be...more

Analysis and Impact of the Improving Medicare Post-Acute Care Transformation Act of 2014

This week, President Obama signed into law the Improving Medicare Post-Acute Care Transformation Act of 2014 (the “IMPACT Act” or “Act”). The IMPACT Act’s provisions will affect a broad range of post-acute care (“PAC”)...more

Health Headlines: Also in the News - September 2014 #3

Congressman Sends Letter to Secretary of HHS Urging Her to Retract CMS’s Global Settlement Offer – On September 15, 2014, Congressman Kevin Brady (R-Tex), Chairman of the House Ways and Means Health Subcommittee, sent a...more

House Passes Bill Requiring Post-Acute Providers to Collect Patient Assessment Data

The House recently passed its version of The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (H.R. 4994/S. 2553), which would require various post-acute providers, including inpatient rehabilitation...more

New Hospice Cost Report Released: Effective for Cost-Reporting Periods Beginning Next Week

On August 29, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released the final version of the new Medicare cost report, Form CMS 1984-14, applicable to freestanding hospice providers. Freestanding hospice...more

Health Update - July 2014

Avoiding the Regulatory Land Mines of Commercial ACOs - While providers are showing great interest in creating ACOs to participate in the Medicare Shared Savings Program (MSSP), they are showing even greater enthusiasm...more

CMS Proposes Changes to Sunshine Act Reporting

Drug and device manufacturers breathing a sigh of relief after completing their 2013 data submissions under the Physician Payment Sunshine Act (the “Sunshine Act’) must now contend with four proposed changes to the Sunshine...more

Cloudy Skies Ahead for Providers? CMS’ Release of Medicare Billing Data Combined with Physician Payment Sunshine Act Data May...

In February 2013, we reported (on our Healthcare Law Blog) that the Centers for Medicare and Medicaid Services (CMS) announced the final rule for the Physician Payments Sunshine Act. In the interest of providing more...more

From Second and State: Capitol Wrap – Week of May 5

House Debates Amendment to Post-Production Costs Bill - An amendment to a bill, which would prevent oil and gas companies from deducting post-production costs from their royalty payments, was debated on the House floor...more

Recent OIG Report Underscores Need for Home Health Agencies and Physicians to Comply With Medicare’s Face-to-Face Documentation...

Medicare overpaid the home health industry $2 billion between January 2011 and December 2012, according to a recent report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG). The OIG’s...more

Proposed Overpayment Reporting Requirements for MA and Part D Programs May Increase False Claims Act Liability

The Centers for Medicare & Medicaid Services continues to take an expansive view of the overpayment refund requirement, which in turn can give rise to False Claims Act liability for Medicare Advantage Organizations and Part D...more

CMS – Doc, if You Want a Free Book Go to the Library

The Centers for Medicare and Medicaid Services (CMS) recently denied a request from a bipartisan group of 23 members of congress to exempt the distribution of textbooks and scientific peer-reviewed medical journal materials...more

Threshold Dollar Amount For Reporting Settlements to Medicare Drops To $2,000; CMS Issues New User Guide

The threshold dollar amount for when private and public employers and insurers are required to report payments to Medicare enrollees pursuant to settlements and judgments has been lowered from $5,000 to $2,000, and will...more

Employers: Did You Meet Your Deadlines?

EEO-1 Report: 9/30/13* Employers with at least 100 employees - *The EEOC’s only remedy for failing to file the forms is to require you to file them. There are no fines or penalties associated with non-filing or...more

Clinical Trial Number Required on Medicare Claims Effective January 1, 2014

Effective January 1, 2014, CMS will require providers and suppliers to report an 8-digit clinical trial number on claims for items or services furnished pursuant to clinical trials that qualify for coverage as set forth in...more

Does District Court Dismissal of Declined Qui Tam Threaten Future DOJ False Claims Enforcement?

The U. S. Department of Justice (DOJ) has taken the unusual step of appealing a federal district court’s dismissal of a declined qui tam brought under the federal and multiple state false claims acts (FCA). Could the...more

The Countdown Begins – Sunshine Act Data Collection

With the August 1 deadline for data collection under the Physician Payments Sunshine Act (the “Act”) looming, CMS recently released two mobile applications (“Apps”) to help physicians and industry track payments and transfers...more

CMS Releases Proposed FFY 2014 SNF PPS Rule

CMS has released its proposed federal fiscal year (FFY) 2014 prospective payment system (PPS) rule for Medicare Skilled Nursing Facilities (SNFs). The rule projects a net increase in operating payments to SNFs in the amount...more

CMS Proposes FY 2014 Payment Rates and Policies for Medicare Inpatient Rehabilitation Facilities

On May 2, 2013, CMS released a proposed rule [PDF] for the Inpatient Rehabilitation Facility Prospective Payment System for fiscal year (FY) 2014. The proposed rule sets forth Medicare payment policies and rates governing...more

CMS Requests Comments on Redundant Reporting of Clinical Quality Measures

CMS is seeking input regarding ways in which eligible professionals might use clinical quality measures (CQM) data reported to medical boards, specialty societies, regional health care quality organizations or other...more

CMS Issues Final Physician Payment Sunshine Act Regulations

On February 1, 2013, the Centers for Medicare and Medicaid Services (CMS) published the long-awaited final regulations implementing the Physician Payment Sunshine Act (Act or Sunshine Act). The Sunshine Act requires drug,...more

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Applicable Manufacturers

“Applicable Manufacturers” - Common Ownership Considered to be Ownership by the Same Individuals or Entities of 5 Percent or More in Two Entities - In the Final Rule, CMS defines “applicable manufacturer” as an...more

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Reports on Physician Ownership...

Reports on Physician Ownership and Investment Interests The Sunshine Act requires applicable manufacturers, as well as applicable GPOs, to report to the Secretary, in electronic form, certain information concerning...more

Healthcare Alert: Better Late than Never - The Sunshine Act Final Regulations are Finally Here!: Report Submission and Review

Report Submission and Review Pre-Submission Review is Not Required Applicable manufacturers may voluntarily provide covered recipients the opportunity to review the data prior to submission to CMS, but doing so is not...more

CMS Releases Final Rule on Physician Payment Disclosures

Public disclosure of payments from pharmaceutical, medical device, biologic, and medical supply manufacturers to physicians and hospitals will begin under a final rule on the Physician Payments Sunshine Act (Sunshine Act)...more

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