Michael Cassidy on Centers for Medicare & Medicaid Services (CMS)

Medicare Proposes 2.8% Physician Fee Schedule Reduction

See below for the CMS (Centers for Medicare & Medicaid Services) Announcement on July 10, 2024 proposing a reduction in the Medicare Conversion Factor payment from $33.29 to $32.36, i.e. 2.8%...more

7/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians , Proposed Rules

Medicare Proposed 2025 Telehealth Changes

CMS proposed several telehealth changes in the 2025 Medicare Physician Fee Schedule Proposed Rule, issued July 10, 2024....more

7/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Amendments , Telehealth , Telemedicine

2024 Medicare Physician Fee Schedule - Update

CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be...more

11/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Physician Fee Schedule , Physicians

Biden Administration to Appeal Surprise Billing Defeat

As reported earlier in the MedLaw Blog (August 9, 2023), a federal District Court vacated portions of the No Surprises Act federal regulations. Thereafter, CMS halted the arbitration process for resolving disputes regarding...more

10/25/2023 / Arbitration , Biden Administration , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , No Surprises Act (NSA) , OPM , Out of Network Provider , Surprise Medical Bills , U.S. Treasury

CMS Halts “No Surprises Act” Arbitration

CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows...more

8/10/2023 / Arbitration , Centers for Medicare & Medicaid Services (CMS) , Dispute Resolution , Health Care Providers , No Surprises Act (NSA) , Out of Network Provider , Surprise Medical Bills

2024 Medicare Physician Fee Schedule

The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75....more

7/17/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Private Equity: Investigation and Enforcement

Since the private equity issue was last addressed in the Bulletin in the Summer of 2022, the volume of healthcare private equity deals has subsided somewhat, according to statistics presented at the March 2023 Pennsylvania...more

5/1/2023 / Acquisitions , Centers for Medicare & Medicaid Services (CMS) , Congressional Investigations & Hearings , Corporate Practice of Medicine , Health Care Providers , Hospitals , Investment , Investors , Motor Vehicle Safety Whistleblower Program (MVSWP) , Private Equity , Private Equity Firms

Reforming Prior Authorization Process: Federal and Pennsylvania

Both the federal government and the Pennsylvania state government are taking steps to reform the prior authorization process. Attached is the Pennsylvania Insurance Department Press Release, issued November 3, 2022, touting...more

12/12/2022 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Department of Insurance , Health Insurance , New Legislation , Prior Authorization

Medicare Proposes 2023 Physician Pay Cuts

On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor. ...more

7/22/2022 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Physician Fee Schedule , Physicians

Congress Extends Telehealth Coverage

The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief. On Tuesday, March 15, 2022, President Biden signed the Consolidated...more

3/21/2022 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Health Care Providers , Medicare , Physicians , Telehealth , Telemedicine , Time Extensions

2022 Medicare Rules for Facility-Based Split/Shared Visits

There has been much discussion and controversy over the new CMS position on billing for split/shared services in facility settings. As originally proposed, and starting in January 2022, if the service was shared among...more

1/24/2022 / Billing , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Facilities , Medicare , Physicians

2022 Federal Compliance Enforcement Outlook

There is almost universal agreement regarding predictions for 2022 federal enforcement in the following areas: ..The use of fraudulently obtained COVID relief funds in both healthcare and in general, but specifically as...more

1/20/2022 / Audits , Centers for Medicare & Medicaid Services (CMS) , Compliance , Coronavirus/COVID-19 , Corporate Misconduct , Department of Justice (DOJ) , Enforcement , False Claims Act (FCA) , Fraud and Abuse , Health Care Providers , Personal Liability , Physicians , Relief Measures , Yates Memorandum

CMS Resumes Targeted Probe and Education (TPE) Program

In the August 12, 2021 MLN Connects News, CMS announced resumption of TPE Program. ...more

8/17/2021 / Centers for Medicare & Medicaid Services (CMS) , Compliance , Health Care Providers , Medicare , Targeted Probe and Education (TPE) audit

Medical Practices Face Liability for COVID Accelerated and Advance Payments and PPP Loans

Medical practices are now beginning to encounter Medicare payment claw backs by CMS for COVID Accelerated and Advanced Payments (CAAP) and Department of Justice (DOJ) prosecution for Paycheck Protection Program (PPP)...more

4/22/2021 / Advanced Payment Program , Centers for Medicare & Medicaid Services (CMS) , Clawbacks , Coronavirus/COVID-19 , Criminal Liability , Criminal Prosecution , Department of Justice (DOJ) , Fraud and Abuse , Health Care Providers , Medicare , Paycheck Protection Program (PPP)

2021 Medicare Fee Schedule Conversion Factor Reduction Reversed

CY 2021 Physician Fee Schedule Update - On December 27, 2020, the Consolidated Appropriations Act modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS)...more

1/15/2021 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Physician Fee Schedule , Physicians

Sprint to Coordinated Care AKS Safe Harbors and Stark Exceptions Finalized

On December 2, 2020, the Department of Health and Human Services (HHS), the Office of Inspector General (OIG) and the Center for Medicare and Medicaid Services (CMS) will jointly publish the final regulations first proposed...more

12/2/2020 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Final Rules , OIG , Safe Harbors , Stark Law , Value-Based Care

Proposed 2021 Medicare Physician Fee Schedule Changes

Attached is a link to the fact sheet for “proposed policy, payment, and quality provisions changes to Medicare physician fee schedule for calendar year 2021”. Among other things, Centers for Medicare & Medicaid Services...more

8/13/2020 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Amendments

CMS 2021 Fee Schedule Expands ASC Procedures

Centers for Medicare & Medicaid Services (CMS) published the new hospital outpatient and ambulatory surgical center fee schedule for 2021 on August 12, 2020. As part of the proposed revisions, CMS intends to transfer over...more

8/13/2020 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule

CMS Issues Blanket Waivers for Stark Physician Self-Referral Law Sanctions

Attached is a PDF issued by CMS regarding blanket waivers of the Stark Law in order to allow physicians and hospitals to adjust 18 different potential financial relationships in order to deal with the COVID-19 emergency. The...more

4/3/2020 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Physicians , Public Health Emergency , Stark Law , Waivers

CMS Eases Enforcement of Open Payment Deadline Reporting: COVID-19

The open payment deadline for reporting is March 31, 2020, but CMS has released an updated FAQ, attached in the link below, indicating that, although the deadline is established by statute and cannot be changed by CMS, CMS...more

3/31/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Open Payments , Relief Measures , Reporting Requirements

Centers for Medicare and Medicaid Services Issue a Telemedicine Tool Kit

The Centers for Medicare and Medicaid Services (CMS.gov) issued a Telemedicine Tool Kit. ...more

3/25/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Relief Measures , Telemedicine

It Is Not Illegal to Pay Physicians More Than They Generate

While we are waiting for final disposition of the AKS Safe Harbors and Stark Exceptions proposed in October of 2019, since the comment period expired December 31, 2019 and final rules have not been issued, I thought we should...more

3/6/2020 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Department of Health and Human Services (HHS) , Exceptions , Fair Market Value , Hospitals , Medicare , Physicians , Proposed Rules , Safe Harbors , Stark Law

Trump Administration Announces Historic Price Transparency Requirements

Attached are links to the CMS Press Release and the Trump Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. The Trump Executive Order was first issued on June 21,...more

11/19/2019 / Centers for Medicare & Medicaid Services (CMS) , Disclosure Requirements , Executive Orders , Health Insurance , Hospitals , New Rules , Transparency , Trump Administration

Regulatory Sprint to Coordinated Care: New Stark & Anti-Kickback Rules

On October 22, 2019, CMS and OIG (Office of Inspector General) released new proposed rules regarding Stark Law Exceptions and Anti-Kickback Safe Harbors in response to what has universally been christened as the “Regulatory...more

11/7/2019 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Exceptions , Health Care Providers , OIG , Physicians , Proposed Rules , Regulatory Requirements , Safe Harbors , Stark Law , Value-Based Care

CMS Expands Medicare Advantage Telehealth Coverage

On April 4, 2019, CMS issued the final Medicare Advantage Rule for calendar year 2020, announcing it will allow Medicare Advantage carriers to significantly increase the range of telehealth services beyond traditional...more

4/30/2019 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Medicare , Medicare Advantage , Telehealth , Telemedicine

Michael Cassidy

Tucker Arensberg, P.C.

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