Summer Swallow

Summer Swallow

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Provider-Based Status Post-BBA: CMS Offers Limited Answers, Requests More Feedback

For those in the hospital industry hoping for additional clarity regarding the operation and billing of provider-based departments (PBDs), the CY 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule provides some...more

7/22/2016  /  Bipartisan Budget Act , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Hospitals , MPFS , Off-Campus Departments , OPPS , Physicians

Medicaid and CHIP Managed Care Final Rule: It’s All About Consistency

The Centers for Medicare & Medicaid Services (CMS) recently issued a 1,425-page regulation (Rule) on managed care in Medicaid and the Children’s Health Insurance Program (CHIP), dubbed the first overhaul of these regulations...more

5/10/2016  /  Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Managed Care Contracts , Medicaid , Medical Loss Ratio

The 2017 Exchange Regulations: Network Adequacy Challenges Remain

The Centers for Medicare and Medicaid Services (CMS) recently issued the final 2017 Benefit and Payment Parameters Rule (Final Rule) and concurrently released a final 2017 Letter to Issuers (Letter to Issuers) in the...more

3/11/2016  /  Centers for Medicare & Medicaid Services (CMS) , Cost-Sharing , Final Rules , Health Care Providers , Health Insurance , Health Insurance Exchanges , NAIC , Patient Safety

Medicaid Managed Care Proposed Rules: The Intersection of Private Insurance and Government Programs

Approximately a quarter of all Medicaid expenditures is spent on the more than half of all beneficiaries (approximately 39 million by 2011 figures cited in the 2014 MACPAC Report) currently accessing part or all of their...more

6/9/2015  /  Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Health Insurance , MACPAC , Managed Care Contracts , MCOs , Medicaid , Proposed Regulation , Qualified Health Plans , Rulemaking Process

Children’s Hospitals Obtain Temporary Injunction Against CMS

Challenging actions by the Centers for Medicare & Medicaid Services (CMS) under the Administrative Procedures Act (APA), Texas Children’s Hospital and Seattle Children’s Hospital obtained a preliminary injunction that enjoins...more

1/16/2015  /  Administrative Procedure Act , Auditors , Centers for Medicare & Medicaid Services (CMS) , Children's Hospital , DSH , Hospitals , Medicaid , Preliminary Injunctions , Reimbursements

Is It a Violation to Help?

In a May 21, 2014, letter to the President of the American Hospital Association (AHA), U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius confirmed HHS’s position that private, not-for-profit...more

5/30/2014  /  American Hospital Association , Centers for Medicare & Medicaid Services (CMS) , Charitable Donations , Department of Health and Human Services (HHS) , Health , Health Insurance Exchanges , Hospitals , Nonprofits , Premiums , Private Foundations , Qualified Health Plans

CMS Issues Final Rule Outlining Medicaid DSH Payment Reductions

CMS recently released the final rule confirming its methodology for carrying out reductions to Medicaid disproportionate share hospital (DSH) payments for fiscal year (FY) 2014 and FY 2015. DSH payments, which go to hospitals...more

9/27/2013  /  Centers for Medicare & Medicaid Services (CMS) , DSH , Final Rules , Healthcare , Medicaid

CMS Provides Guidance For Amending Patient Medical Records

CMS recently released a transmittal providing instructions to contractors on acceptable methods for providers to amend, correct and incorporate delayed entries into a patient medical record. ...more

1/23/2013  /  Centers for Medicare & Medicaid Services (CMS) , Corrections , Medical Records

Health Law Update — January 10, 2013

In This Issue: - Healthcare Provisions in the American Taxpayer Relief Act - the Good, the Bad and the Ugly - American Taxpayer Relief Act Amends Overpayment Recovery Time Limits - OIG Advisory Opinion Sheds...more

1/14/2013  /  American Taxpayer Relief Act , Centers for Medicare & Medicaid Services (CMS) , Data Breach , Electronic Medical Records , Fraud , Healthcare , OCR , OIG , Overpayment Recovery Time Limits , Pay-for-Performance , Reporting Requirements , Settlement
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