Under the CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposes several modifications to the Medicare Shared Savings Program (MSSP) that would become effective in performance year 2025. CMS also proposed...more
The Centers for Medicare & Medicaid Services (CMS) proposed to extend a number of COVID-era regulatory flexibilities related to telehealth, remote services, and supervision in the CY 2025 Medicare Physician Fee Schedule (PFS)...more
7/30/2024
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Healthcare ,
Medicare ,
Mental Health ,
Physician Fee Schedule ,
Physicians ,
Proposed Rules ,
Substance Abuse ,
Telehealth ,
Telemedicine
After more than three years, the Public Health Emergency (PHE) related to COVID-19 is scheduled to end on Thursday, May 11, 2023. The PHE declaration under the Public Health Service Act has allowed the Secretary of the...more
Over the past year, the Biden administration has expressed serious doubts about the developing role of private equity investment in the long term care industry. In a Fact Sheet released in late February 2022, the White House...more
On January 1, 2023, Medicare began paying for services provided at Rural Emergency Hospitals (REHs), a newly created provider type established to preserve access to emergency health care in rural areas and avert closure of...more
The New York State Department of Financial Services (Department) announced that it is requesting public comments on the Practice of Patient-Steering by Pharmacy Benefit Managers in New York State. Pharmacy Benefit Managers...more
The Centers for Medicare & Medicaid Services (CMS) issued a Final Rule on November 15, 2021, (November 2021 Final Rule) repealing its regulatory definition of "reasonable and necessary," which had previously been finalized in...more
The Centers for Medicare & Medicaid Services' (CMS) FY 2022 Budget Justification request to Congress suggests an increased focus on Medicare claim reviews and an effort to decrease the number of claim denials overturned...more
In a recent win for teaching hospitals, the U.S. District Court for the District of Columbia invalidated a CMS regulation implementing the direct graduate medical education (DGME) cap on full-time equivalent (FTE) residents....more
On December 23, 2020, the OIG published Advisory Opinion 20-06, concluding that it would not impose penalties or sanctions under either the beneficiary inducement prohibitions of the civil monetary penalty statute (CMP) or...more
On August 11, 2020, the Department of Health and Human Services announced that it is expanding the alternative dispute resolution process known as Settlement Conference Facilitation (SCF) for 2020. Under the expansion,...more
On June 30, 2020, Centers for Medicare and Medicaid Services (CMS) published a proposed rule that includes new provisions implementing the home infusion therapy (HIT) benefit category and outlines enrollment standards for HIT...more
CMS recently issued its second round of changes to the Medicare regulations in response to the COVID-19 Public Health Emergency (PHE). CMS published its first interim final rule with comment period addressing the PHE in the...more
In response to the disruptive Supreme Court decision on the impact and effect of administrative guidance, HHS has issued a memorandum suggesting that CMS's ability to enforce some of its payment policies may be limited by the...more
12/18/2019
/ Administrative Agencies ,
Administrative Law Judge (ALJ) ,
Azar v Allina Health Services ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Local Coverage Determinations (LCDs) ,
Notice and Comment ,
Physicians ,
Policy Memorandums ,
Proposed Guidance ,
Rulemaking Process ,
SCOTUS ,
Self-Referral
In a recent advisory opinion, the OIG permitted a federally funded community health center to purchase real estate from an entity owned, in part, by an individual who was excluded from participation in federal health care...more
While many Medicare providers and suppliers may not yet have experienced a Targeted Probe and Education (TPE) audit, they should be on the lookout for this newest weapon in the medical review arsenal. It is important that...more
2/15/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Code of Federal Regulations (CFR) ,
Compliance ,
Health Care Providers ,
Integrity Policies ,
MACs ,
Medical Supplies ,
Medicare ,
Medicare Billing Privileges ,
Suppliers ,
Targeted Probe and Education (TPE) audit
In Advisory Opinion 18-10, issued September 10, 2018, the OIG permitted a manufacturer of surgical devices and wound care products to implement a warranty program under which the manufacturer's hospital customers could...more
11/30/2018
/ Advisory Opinions ,
Anti-Kickback Statute ,
Hospitals ,
Manufacturers ,
Medical Devices ,
Medicare ,
OIG ,
Physicians ,
Safe Harbors ,
Surgical Center Requirements ,
Warranties
In Advisory Opinion No. 18-07, issued July 30, 2018, the OIG permitted a group purchasing organization (GPO) to serve health care facilities owned by the same parent organization as the GPO. While acknowledging that the...more
The OIG added six new items to its Work Plan in the July 2018 update. Areas addressed include HHS cybersecurity vulnerabilities, increased payments for transfer claims with outliers, oversight of funds for Access Increases in...more
8/2/2018
/ Children's Health Insurance Program (CHIP) ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Mental Health ,
OIG ,
Outlier Payments ,
Physicians ,
Provider Payments ,
SAMHSA ,
Substance Abuse ,
Work Plans
The OIG created an opening for nursing facility discounts to private payors when it approved a startup company's proposal to create a network of nursing facilities willing to offer discounts on the daily rates charged to...more
On December 13, 2016, President Obama signed the 21st Century Cures Act ("Cures Act"), H.R. 34, into law. It enjoyed bipartisan support and was overwhelmingly approved by the House and Senate in recent weeks. The expansive...more