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Texas Revises Change of Ownership (CHOW) Requirements for Certain Healthcare Provider Types

The Texas Health and Human Services Commission, on behalf of the Department of Aging and Disability Services (DADS), has adopted revised regulations that impact the Change of Ownership (CHOW) process and requirements for...more

D.C. Circuit Finds District Court Abused Discretion by Implementing a 4 Year Deadline to Clear Backlogged Administrative Appeals

On August 11, 2017, the D.C. Circuit issued its decision on the District Court’s order in American Hospital Association v. Price in a 2-1 decision, holding that the District Court abused its discretion by ordering the...more

CMS Issues Guidance to Change Medical Reviewer Requirements for Complex Medical Reviews

Effective September 12, 2017, the Centers for Medicare & Medicaid Services (CMS) will implement changes to ensure that complex reviews for coverage determinations are performed by Registered Nurses (RNs), therapists, or...more

CMS Finalizes 6 Month Delay for New Home Health Agency Conditions of Participation

On July 7, 2017, the Centers for Medicare & Medicaid Services (CMS) announced a final rule to delay the effective date of the new conditions of participation (CoPs) for home health agencies, which is scheduled to be published...more

Medicare’s Pre-Claim Review Demonstration Project to Begin in Florida

In August 2016, the Centers for Medicare & Medicaid Services (CMS) initiated a three-year Pre-Claim Review Demonstration for home health agencies (HHA) in Illinois, with plans to expand the demonstration shortly afterwards to...more

HHS Announces Final Rule to Remedy Medicare Appeals Backlog

On January 17, 2017, the Department of Health and Human Services (HHS) released a Final Rule announcing a three-prong appellate process change in an effort to decrease the growing Medicare appeals backlog at the...more

“Should Auld Acquaintance Be Forgot” - Performant to Initiate Home Health, Hospice, and DME Audits in 2017

The final quarter of 2016 ended with the Centers for Medicare & Medicaid Services (CMS) announcing Performant Recovery, Inc. (Performant) as the new national Recovery Audit Contractor (RAC) to focus solely on Home Health,...more

Medicare Proposes Tiered Outpatient Therapy Evaluation Codes for 2017

In July, the Centers for Medicare & Medicaid Services (CMS) announced its intent to add several new codes for physical therapy and occupational therapy evaluation under the Medicare Physician Fee Schedule Proposed Rule for...more

CMS Limits the Scope of Review for Certain Redeterminations and Reconsiderations

For providers who have received inconsistent or varying reasons for denial while navigating through the Medicare appeals process, the Centers for Medicare & Medicaid Services (CMS) has provided much-needed relief in the form...more

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