In recent years, the Centers for Medicare and Medicaid Services (CMS) has expanded coverage for remote patient monitoring (RPM) services under Medicare. RPM services include establishing, implementing, revising, and...more
12/20/2019
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Data Management ,
Data Privacy ,
Digital Health ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Licensing Rules ,
Medical Monitoring ,
Telehealth ,
Telemedicine
Late last week, the Centers for Medicare & Medicaid Services (“CMS”) released the CY 2020 Hospital Outpatient Prospective Payment System (“OPPS”) final rule [CMS-1717-FC]. While many hospitals had hoped for relief from recent...more
11/6/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Coding ,
Drug Pricing ,
Final Rules ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
Medicaid ,
Medicaid Reform ,
Medicare ,
Medicare Payment Reform ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Pharmaceutical Industry ,
Prescription Drugs ,
Price Transparency ,
Recovery Audit Contractors (RACs) ,
Rulemaking Process ,
Section 340B
This past week, CMS confirmed it will continue the 2018 and 2019 underpayment policy for certain 340B covered entities unless the D.C. Court of Appeals upholds the lower court’s ruling that it is unlawful. In that case, CMS...more
8/6/2019
/ Administrative Procedure Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Health Care Providers ,
Healthcare Reform ,
MACs ,
Medicare Payment Reform ,
Payment Rates ,
Pharmaceutical Industry ,
Prescription Drugs ,
Proposed Rules ,
Regulatory Agenda ,
Remedies ,
Rulemaking Process ,
Section 340B ,
Underpayment
In this issue, Polsinelli’s 340B and Reimbursement teams provide an update on the most recent developments in the ongoing 340B /Part B Payment litigation and also highlight recent Government Accountability Office (“GAO”)...more
5/16/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Drug Pricing ,
GAO ,
Health Care Providers ,
HRSA ,
Medicaid ,
Pharmaceutical Industry ,
Prescription Drugs ,
Provider Payments ,
Section 340B
The HHS Office for Civil Rights (“OCR”) issued a notice in the Federal Register regarding its Enforcement Discretion (84 Fed. Reg. 18151) on April 30, 2019. HHS announced that HHS will now apply a different cumulative annual...more
5/15/2019
/ Civil Monetary Penalty ,
Data Breach ,
Electronic Medical Records ,
Enforcement Authority ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Breach ,
HITECH Act ,
Information Technology ,
OCR ,
Personally Identifiable Information ,
PHI
A federal district court granted a permanent injunction against the Medicare Part B 2018 Outpatient Prospective Payment System (“OPPS”) payment cuts for separately payable, non-pass through drugs purchased through the 340B...more
1/7/2019
/ Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Hospitals ,
Low-Income Issues ,
Medical Reimbursement ,
Medicare ,
Medicare Part B ,
Outpatient Prospective Payment System (OPPS) ,
Permanent Injunctions ,
Prescription Drugs ,
Section 340B
Recently HHS announced two initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge level: (i) expand the Settlement Conference -
Facilitation (SCF) program and (ii) offer a new Low...more
The LVA settlement option is being offered to providers and suppliers with fewer than 500 Part A and B claims pending as of Nov. 3, combined, where no single claim appeal exceeds $9,000. These appeals will be settled at 62...more
The Medicare Learning Network (MLN) recently held a second call, where it answered questions live about the Low Volume Appeals (LVA) Settlement Option and revealed more information that providers considering the option need...more
Significant Medicare Part B reimbursement rate cuts and burdensome claim modifiers apply to certain drugs purchased by hospitals through the 340B drug discount program effective on Jan. 1, 2018 after a federal judge declined...more
Under the 21st Century Cures Act (Cures Act), the Health and Human Services (HHS) Secretary is mandated to have promulgated regulations by Dec. 13, 2017 that, among other requirements, prohibit “information blocking” as a...more