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Unpacking CMS's Proposed Rule for Correcting Underpayments for 340B Drug Reimbursement

In this episode, Darlene Davis, Leah Richardson, and Andrew Ruskin unravel CMS’s proposed rule for the remedy for Medicare payments for drugs purchased under the 340B Program and reimbursed as hospital outpatient services....more

Rural Emergency Hospitals: CMS Finalizes Key Policies for New Medicare Provider Type (Part 2 of 2)

On 1 November 2022, the Centers for Medicare & Medicaid Services (CMS) published the 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (the OPPS Final...more

Health Care Triage: New Data Available Under the Hospital Price Transparency Rule

In this episode, Darlene Davis, Andrew Ruskin, and Lauren Norris Donahue review data that is now available in light of the hospital price transparency rule. They discuss the recent increase in compliance among hospitals,...more

Rural Emergency Hospitals: CMS Finalizes Key Policies for New Medicare Provider Type (Part 1 of 2)

On 1 November 2022, the Centers for Medicare & Medicaid Services (CMS) published the 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (the OPPS Final...more

Rural Emergency Hospitals: CMS Publishes Proposed Enrollment and Payment Policies for New Medicare Provider Type

On 26 July 2022, the Centers for Medicare & Medicaid Services (CMS) published the 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (the OPPS Proposed...more

New Options for Rural Hospitals: CMS Proposes Conditions of Participation for New "Rural Emergency Hospital" Provider Category

On 6 July 2022, the Centers for Medicare & Medicaid Services (CMS) published a rule proposing the Conditions of Participation (CoPs) for Medicare and Medicaid participation of rural emergency hospitals (REHs), to be codified...more

Health Care Triage: Hospitals, Physician Practices, and Labs – Are You Ready to Report Private Payor Rates for Laboratory Tests?

In this episode, Gabriel Scott and Darlene Davis analyze the private payor rates reporting requirements under the Protecting Access to Medicare Act. They discuss the type of entities required to report, potential penalties...more

2022 OPPS Final Rule Overview: CMS Finalizes Policies on 340B, Hospital Price Transparency, and Inpatient Only List

On 2 November 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Payment System final rule (OPPS Final Rule), in which the...more

Health Care Triage: An Update on the CMS Hospital Price Transparency Rule

In this week’s episode, Darlene Davis interviews Andrew Ruskin about updates to the CMS Hospital Price Transparency rule now that it has been in effect for almost one year. The presenters discuss the expanded scope of pricing...more

CMS Proposes to Increase Penalties for Hospital Price Transparency Noncompliance

On 19 July 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Outpatient Prospective Payment System/Ambulatory Surgery Center Payment System proposed rule (OPPS Proposed Rule),1 which includes a...more

COVID-19: Navigating the Path to Recovery - Planning for Life After 1135 Waivers and Other Regulatory Flexibility Ends (Part 1)

INTRODUCTION - The U.S. Department of Health and Human Services (HHS) and its operating and staff divisions (HHS Divisions) have granted an unprecedented amount of regulatory flexibility to aid health care providers in their...more

COVID-19: CMS Releases Additional Blanket Waivers and Flexibilities

On 30 April 2020, the Centers for Medicare & Medicaid Services (CMS) released additional blanket waivers under Section 1135 of the Social Security Act and rules changes though an Interim Final Rule with Comment Period (IFC),...more

COVID-19: EMTALA Guidance on COVID-19 While Hospitals Await Potential EMTALA Waivers

On March 9, 2020, the Centers for Medicare and Medicaid Services (“CMS”) issued guidance to State Survey Agency Directors regarding Emergency Medical Treatment and Labor Act (“EMTALA”) requirements and implications related to...more

CMS Finalizes Hospital Price Transparency Rule and Proposes New Transparency Requirements for Health Plans

On November 15, 2019, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule that will require hospitals to make public a list of their standard charges for items and services furnished to patients starting...more

CMS Issues Long-Awaited Draft Guidance on Hospital Co-Location and Space Sharing

Summary - On May 3, 2019, the Centers for Medicare & Medicaid Services (“CMS”) issued long-awaited draft guidance addressing compliance with the hospital Conditions of Participation (“CoPs”) and survey procedures in regard...more

CMS Issues Final Medicare PFS Rule for CY 2019

On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released in pre-publication form the Medicare Physician Fee Schedule (PFS) Final Rule for Calendar Year (CY) 2019 (PFS Final Rule)....more

CMS Issues Proposed Medicare PFS Rule for CY 2019

On July 27, 2018, the Medicare Physician Fee Schedule (PFS) Proposed Rule for Calendar Year (CY) 2019 (PFS Proposed Rule) was published in the Federal Register....more

CMS Issues Proposed OPPS Rule for CY 2019

On July 31, 2018, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule for the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory Surgical Center payment...more

K&L Gates Triage: Proposed Changes to the Federal Satellite Facility Rules

The Centers for Medicare & Medicaid Services (“CMS”) recently proposed certain changes to the existing satellite facility rules in its Inpatient Prospective Payment System (“IPPS”) and Long Term Acute Care Hospital (“LTCH”)...more

U.S. District Court Upholds CMS’s Application of the Statutory Requirement that Hospitals Be “Primarily Engaged” in Providing...

On January 25, 2018, the U.S. District Court for the Eastern District of Pennsylvania granted summary judgment in favor of the Centers for Medicare & Medicaid Services (“CMS”) following an eye hospital’s appeal of the...more

Medicare Diabetes Prevention Program Enrollment is Now Open

As of January 1, 2018, the Centers for Medicare & Medicaid Services (“CMS”) began enrolling suppliers in its new Medicare Diabetes Prevention Program (“MDPP”). If successfully enrolled prior to April 1, 2018, MDPP suppliers...more

CMS Finalizes Changes in CY 2018 OPPS and PFS Final Rules

On November 1, 2017, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule with comment period revising the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory...more

CMS Finalizes Rule Establishing New Emergency Preparedness Requirements

As clean-up efforts continue in the wake of Hurricane Matthew, companies in North Carolina, South Carolina, Georgia, Florida, and throughout the Southeast are focused on the importance of emergency preparedness in ensuring...more

New Law Excludes New Provider-Based Off-Campus Outpatient Hospital Locations from OPPS

On November 2, 2015, President Barack Obama signed into law a bill that significantly changes how Medicare pays for outpatient services furnished at certain hospital locations. The Bipartisan Budget Act of 2015 (“BBA”)...more

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