On August 27, 2018, the Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) published a request for information (RFI) inviting comments regarding the Anti-Kickback Statute and Beneficiary...more
On August 3, 2018, the U.S. District Court for the Western District of Texas denied a challenge by Superior Home Health Services (Superior Home Health) to a Medicare contractor’s use of extrapolation to determine that the...more
On July 2, 2018, CMS issued a proposed rule (CMS-1689-P) outlining proposed Calendar Year (CY) 2019 Medicare payment updates and proposed quality reporting changes for home health agencies (HHAs). CMS projects that payments...more
On June 4, 2018, the United States Court of Appeals for the Fourth Circuit affirmed the dismissal of antitrust claims brought by Providence Hospital alleging that Palmetto Health carried out an anticompetitive scheme to...more
A Federal judge granted a request to intervene in the Texas et al. v. United States et al., No. 4:18-cv-00167-O, lawsuit pending in the U.S. District Court in the Northern District of Texas from a group of State Attorneys...more
On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) Proposed Rule (CMS-1694-P). Among other changes, CMS proposes eliminating...more
On February 9, 2018, the U.S. Department of Justice (DOJ) announced it reached a proposed settlement with Henry Ford Allegiance Health (Allegiance) over allegations that Allegiance conspired with rival hospitals to engage in...more
On January 24, 2018, advocacy groups filed a lawsuit on behalf of a group of Kentucky Medicaid recipients in the U.S. District Court for the District of Columbia seeking class action status in an effort to stop new work...more
In December 2017, the Medicare Payment Advisory Commission (MedPAC) issued a report to Congress analyzing the impact of physician supervision requirements in critical access hospitals (CAHs) and small rural hospitals. ...more
The Department of Health and Human Services (HHS) Departmental Appeals Board (DAB) has requested suggestions for Medicare Appeals Council (Council) decisions that should be designated as precedential. The Council provides...more
Last week, HHS OIG released a report finding that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, such as long-term care hospitals,...more
On August 14, 2017, CMS announced an expansion of a Targeted Probe and Educate (TPE) review strategy for Medicare Administrative Contractors (MAC) reviews. Many providers were familiar with Probe and Educate reviews in...more
On June 16, 2017, the Department of Justice announced that Genesis Healthcare paid $53.6 million to resolve six False Claims Act whistleblower lawsuits filed by seven of Genesis’ former employees. The lawsuits alleged that...more
Although the Two Midnight Rule became effective on October 1, 2013, CMS had not updated manual guidance to incorporate the Two Midnight Rule until recently. The CMS updated the Medicare Benefit Policy Manual earlier this...more
The CY 2016 OPPS Final Rule, issued on October 30, 2015, instituted new cost reporting rules prohibiting MACs from paying items that a provider has not claimed or protested on its as-filed cost report. Importantly, these...more
In a status report filed on March 6, 2017, HHS revised projections regarding the Medicare appeals backlog, which make it unable to meet a court-imposed deadline to eliminate the backlog by 2020. The status report was filed in...more
On February 8, 2017, the United States District Court for the District of Connecticut declined to fully dismiss allegations filed by a class of Medicare patients against HHS in Alexander et al. v. Cochran (formerly Bagnall et...more
Although the Two Midnight Rule was effective October 1, 2013, until recently, CMS had not updated the Medicare Benefit Policy Manual (MBPM) to incorporate the Two Midnight Rule and its revisions to prior admission...more
This week, the Senate and the House are expected to approve an FY 2017 budget resolution instructing congressional committees to write legislation, known as budget reconciliation bills, to rescind many key components of the...more
On December 6, 2016, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) issued a Committee staff report detailing concurrent and overlapping surgery practices. The report also offers...more
On November 3, 2016, CMS announced details for a new Hospital Appeals Settlement program to permit eligible providers to settle certain inpatient status claims currently under appeal. According to CMS, the purpose of the 2016...more
On October 14, 2016, CMS issued its Final Rule for the new physician payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the Medicare Sustainable Growth Rate (SGR) with a new...more
10/25/2016
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
EHR ,
Final Rules ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
MIPS ,
Payment Systems ,
Physician Payments ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR) ,
Value-Based Payments