CMS finalized a rule last month that will significantly expand access to telehealth services for patients in Medicare Advantage plans. Implementing provisions of the Bipartisan Budget Act of 2018 (BiBA), the new rule will...more
The Office of Inspector General Portfolio Report is a rehash of the watchdog agency’s 2006–2016 findings on quality of care concerns and program integrity issues. The report, which garnered some critical press attention for...more
Mixing innovative change with standing policy, the proposed physician fee schedule rule for CY 2019 highlights a Medicare payment system in transition. Clinicians and groups focused solely on driving volume without devoting...more
The Centers for Medicare & Medicaid Services recently expanded its national audit strategy, titled “Targeted Probe and Educate,” for Medicare billing review after pilot programs with four Medicare Administrative Contractors...more
OIG Advisory Opinion paves the way for expanded retailer reward programs.
The US Department of Health and Human Services Office of Inspector General (OIG) issued an advisory opinion on September 7 that provides important...more
The law would prohibit most gifts to healthcare professionals and providers....more
State legislature passes bill to expand telemedicine practice.
The last six years have been a wild ride for telehealth providers in Texas. When the Texas Medical Board (TMB) issued emergency rules in 2011 that required...more
Given that Republicans will soon control both Congress and the White House, hospitals may be concerned that expenditures that have helped reduce the ranks of the uninsured will be ratcheted down. However, forward-thinking...more
A new report suggests that the Stark law is obsolete in new payment models.
On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more
7/7/2016
/ Affordable Care Act ,
AHLA ,
Alternative Payment Models (APM) ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
False Claims Act (FCA) ,
Fraud Abuse and Waste ,
Health Care Providers ,
Legislative Agendas ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Physicians ,
Repeal ,
Stark Law
The report finds that PODs increase overutilization, lack transparency, and increase the risk of patient harm and warns that hospitals must combat the growing threat of PODs.
On May 10, the US Senate Committee on Finance...more
The report shows significant lapses in 2012 GIP service claims and recommends that CMS implement additional oversight and enforcement options....more
Follow these tips to ensure compliance in the wake of the new 60-Day Rule.
On February 12, the CMS finalized the 60-Day Overpayment Report and Refund rule (60-Day Rule) for Medicare Parts A and B. This long-awaited rule...more
The final rule relaxes the requirements on “identification” and look-back period.
The Centers for Medicare & Medicaid Services (CMS) has released its long-awaited final rule related to the reporting and refunding of...more
The new clarifications suggest a more lenient CMS, but providers shouldn’t compromise their compliance standards.
Throughout the halls of hospitals’ legal and compliance departments, people have been talking....more
Tips on preserving the provider-based status for existing clinics.
The Bipartisan Budget Act of 2015 (H.R. 1314) was signed into law on Monday, November 2. Notwithstanding significant concerns raised by the hospital...more
11/4/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Critical Access Hospitals ,
Federal Budget ,
Health Care Providers ,
Healthcare ,
Hospitals ,
HRSA ,
Medicaid ,
Medicare ,
New Legislation ,
OPPS ,
Provider Payments ,
Section 340B ,
State Medicaid Programs
Hospitals that seek to establish provider-based OPDs should complete their work soon.
A near-final discussion draft of a House budget bill, which the White House has apparently agreed to in principle, would end the...more
Major changes to Stark law are ahead, including new exceptions for timeshare arrangements and employment of NPPs.
The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on July 8 for the 2016...more
7/10/2015
/ ACOs ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Client Referrals ,
Comment Period ,
Exceptions ,
FQHC ,
Healthcare ,
Hospitals ,
Medicaid ,
Medicare ,
Physician Fee Schedule ,
Physicians ,
Proposed Regulation ,
Rural Health Care Providers ,
Stark Law
The OIG’s recently released study examining Medicare hospice claims from 2007 to 2012 calls for targeted reviews of hospices that receive a high proportion of their payments for care in assisted living facilities....more
CMS reconsiders $10 million bounties for reporting of regulatory violations.
On December 5, the Centers for Medicare & Medicaid Services (CMS) finalized a rule (the Final Rule) that expands its program integrity and...more
The proposed rule to give providers more protections to promote beneficiary access to care solicits significant industry input.
On October 2, the Department of Health and Human Services (HHS) Office of Inspector...more
10/6/2014
/ Affordable Care Act ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Gainsharing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Hospitals ,
OIG ,
Proposed Regulation ,
Safe Harbors