Latest Publications

Share:

CMS Finalizes the Physician Fee Schedule Rule for Calendar Year 2021

On December 2, 2020, CMS issued a final rule updating the payment policies and rates for services to be furnished under the Medicare Physician Fee Schedule (PFS) in calendar year (CY) 2021. The final rule includes...more

HHS to Distribute $333 Million in Performance Incentive Payments to Nursing Homes for Curbing COVID-19 Infections and Deaths

On October 28, 2020, HHS announced that it would distribute $333 million to nursing homes that demonstrated significant reductions in COVID-19-related infections and deaths in September. “These $333 million in performance...more

CMS Issues Medicare IPPS and LTCH Final Rule for FY 2021

On September 2, 2020, CMS issued the fiscal year (FY) 2021 final rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Final Rule). This article...more

CMS Issues Instructions for MACs to Adjust Part C Payments for Nursing and Allied Health and Direct Graduate Medical Education...

On August 21, 2020, CMS issued a transmittal (Change Request 11642) instructing Medicare Administrative Contractors (MACs) to recalculate the Part C components of nursing and allied health (NAH) and direct graduate medical...more

D.C. District Court Upholds Price Transparency Rule

On June 23, 2020, Judge Carl Nichols of the United States District Court for the District of Columbia issued a decision upholding CMS’s price transparency rule, which was adopted late last year. The case is cited as American...more

CMS Proposes Retroactive Codification of “Longstanding” Bad Debt Policies in IPPS Proposed Rule

In the Medicare inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2021 (the Proposed Rule), CMS has proposed to amend its existing bad debt regulation to incorporate the agency’s bad debt policies...more

Third Circuit Rules that Clinical Judgments Are Falsifiable; Can Trigger FCA Liability

Last week, the United States Court of Appeals for the Third Circuit held that prognoses of terminal illness submitted in support of hospice claims for reimbursement could be actionable false statements under the False Claims...more

Proposed Budget Would Cut Medicare and Medicaid Funding in FY 2021

On February 10, 2020, the White House unveiled its proposed budget (the Budget) for FY 2021, which would decrease funding for HHS by 10 percent. Medicare and Medicaid would bear the brunt of these cuts. For both programs...more

GAO Report Claims 340B Program Needs More Oversight of Hospitals

On January 10, 2020, the U.S. Government Accountability Office (GAO) issued a report claiming that the Health Resources and Services Administration (HRSA) does not use adequate controls to confirm the eligibility of private...more

Eleventh Circuit Denies Preliminary Injunction for New National Liver Transplant Allocation Policy

On September 25, 2019, the United States Court of Appeals for the Eleventh Circuit affirmed a lower court’s decision to deny a motion for a preliminary injunction to stay the implementation of the new policy for allocating...more

CMS Issues FY 2020 Inpatient PPS and Long-Term Care Hospital PPS Final Rule

On August 2, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2020 (the Final Rule). Highlights include...more

Florida Hospitals Prevail in Litigation Challenging the Exclusion of Low Income Pool Days from the Medicare Disproportionate Share...

On July 23, 2019, Judge Rosemary Collyer of the United States District Court for the District of Columbia issued an opinion ruling in favor of ten Florida hospitals in their case challenging the calculation of their Medicare...more

Fifth Circuit Orders CMS to Count Mississippi Hospitals’ UCCP Days in the Medicaid Fraction of the Medicare DSH Payment Formula

In a ruling dated June 10, 2019, the United States Court of Appeals for the Fifth Circuit sided with Mississippi hospitals in a dispute over the calculation of the Medicare DSH payment. Forrest General Hospital v. Azar, No....more

CMS Releases FY 2020 Medicare IPPS and LTCH PPS Proposed Rule and Proposes Key Changes to Several Regulatory Requirements

On April 23, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2020 (the Proposed Rule), which will affect...more

CMS Issues Proposed Rulemaking for the FY 2020 Inpatient Psychiatric Facilities Prospective Payment System

The display copy of the proposed rulemaking for the FY 2020 Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) was posted on the Federal Register website last week (the Proposed Rule). The IPF PPS pays...more

CMS to Begin Enforcing “Longstanding” Accounting Classification Rule for Crossover Bad Debts

Last week, CMS announced on its website that for cost reporting periods beginning on or after October 1, 2019, providers must comply with a so-called “longstanding” rule to claim reimbursement for crossover bad debts from the...more

Eighth Circuit Upholds CMS’s Methodology for Calculating the Volume Decrease Adjustment for Cost Reporting Periods Preceding...

Last week, the United States Court of Appeals for the Eighth Circuit issued a consolidated opinion for three cases in which it upheld the methodology that CMS used to calculate the volume decrease adjustment (VDA) for...more

Rhode Island Governor Establishes Growth Target of 3.2 Percent on Annual Healthcare Spending

Rhode Island is the second state to attempt to limit how much healthcare costs can increase each year by establishing a target or benchmark. Massachusetts implemented a benchmark in 2012. Delaware is expected to follow suit...more

AdvaMed Updates Code of Ethics for Interactions with Healthcare Professionals

For the first time in nearly a decade, the Advanced Medical Technology Association (AdvaMed) has updated its Code of Ethics on Interactions with Heath Care Professionals (HCPs) in the United States (the Code or the AdvaMed...more

CMS Publishes Additional Guidance Regarding the Price Transparency Requirements for Hospitals

In early December, CMS posted on its website a second round of FAQs about the price transparency guidelines the agency adopted earlier this year in the inpatient prospective payment system (IPPS) rulemaking for federal...more

HHS Proposes to Halt Further Delays of 340B Oversight and Enforcement Rules

The Department of Health and Human Services (“HHS”) has proposed to accelerate the implementation of regulatory changes designed to protect hospitals from being overcharged for drugs purchased under the 340B Drug Pricing...more

CMS Begins Audits of Worksheet S-10 for FY 2015 Cost Reports

In the Inpatient Prospective Payment System (IPPS) rulemaking for fiscal year (FY) 2019, the Centers for Medicare and Medicare Services (CMS) announced that it would begin auditing the charity care and bad debt costs...more

D.C. Circuit Clears the Way for Hospitals to Challenge Base-Year Factual Determinations

The United States Court of Appeals for the District of Columbia Circuit recently held in Saint Francis Medical Center v. Azar that Medicare’s reopening regulation, which prohibits providers from seeking to revise payment...more

CMS Issues New Instructions for Completing Worksheet S-10 and Extends Deadline for Providers to Submit Updated Data for FYs 2014...

For the second time in less than one year, CMS has updated its instructions for completing Worksheet S-10 of the Medicare cost report for hospitals. The new instructions expand the definition of charity care, as reported in...more

51 Results
 / 
View per page
Page: of 3

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide