Kathleen Salsbury on Centers for Medicare & Medicaid Services (CMS)

CMS Proposes Significant Changes to the Medicare Shared Savings Program and 60-Day Rule

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

8/9/2024 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medical Reimbursement , Medicare , Overpayment , Physician Fee Schedule , Physicians

CMS Proposes Extending COVID-Era Telehealth and Supervision Flexibilities through CY 2025

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

COVID-19 Public Health Emergency Set to End May 11, 2023, Along with Many Waivers and Flexibilities

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

5/10/2023 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Long Term Care Facilities , Medicare , Public Health Emergency , Reimbursements , Self-Referral , Telehealth

CMS Guidance on Rural Emergency Hospitals

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

2/13/2023 / Centers for Medicare & Medicaid Services (CMS) , Critical Access Hospitals , Health Care Providers , Hospitals , Reimbursements , Rural Health Care Providers

CMS Finalizes Repeal Of Regulatory Definition Of "Reasonable And Necessary"

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

12/24/2021 / Centers for Medicare & Medicaid Services (CMS) , Health Insurance , Healthcare Reform , Medical Reimbursement , Medicare , Medicare Part A , Medicare Part B , Reasonable and Necessary Expenses , Regulatory Standards

CMS Budget Justification Requests Increased Audit and Appeals Funding

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

7/28/2021 / Audits , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , MACs , Medicare , Reimbursements

Federal Court Strikes Down CMS Direct Graduate Medical Education Payment Regulation That Reduced Count of Certain Residents

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

6/17/2021 / Centers for Medicare & Medicaid Services (CMS) , GME , Hospitals , Reimbursements , Teaching Hospitals

CMS Issues Proposed Enrollment Standards for Home Infusion Therapy Suppliers

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

7/17/2020 / Accreditation , Applications , Centers for Medicare & Medicaid Services (CMS) , Home Health Care , Medical Supplies , Proposed Rules , Public Comment , Revocation , Suppliers

CMS's Second Interim Final Rule Further Expands Telemedicine, Service Availability and Payment Flexibilities Related to the...

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

5/23/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Interim Final Rules (IFR) , Public Comment , Retroactive Application , Telemedicine , Temporary Regulations

HHS Memorandum Clarifies CMS Obligations Following Supreme Court Allina Decision

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

Medicare Target, Probe and Education Audits Require Immediate and Full Attention from Providers/Suppliers

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

Kathleen Salsbury

Baker Donelson

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