News & Analysis as of

Centers for Medicare & Medicaid Services

CMS Releases Final 2018 Medicare Payment Regulations

by Baker Donelson on

On November 1 and 2, the Centers for Medicare and Medicaid Services (CMS) released the final 2018 Medicare Payment Regulations for the Physician Fee Schedule, Hospital Outpatient Prospective Payment System and Ambulatory...more

MACRA Final Rule Continues Gradual Transition and Provider Flexibility for 2018

by Baker Donelson on

On November 2, the Centers for Medicare and Medicaid Services (CMS) released the final rule implementing policies for Year 2 (2018) of the Quality Payment Program established under the Medicare Access and CHIP Reauthorization...more

News from Second & State

Weekly Wrap - It was back to business as usual this week in Harrisburg, as the Senate returned for three days of voting session. While not in session, the House of Representatives was also busy, holding some public...more

CHIP Reauthorization Stalls in Congress, Increasing Fiscal Pressure on States

by Baker Donelson on

Reauthorization of federal funding for the Children's Health Insurance Program (CHIP) has stalled in Congress due to partisan disagreements over fiscal offsets. The delay in the extension of federal funding has put...more

Affordable Care Act Initially Fades from Spotlight; Reemerges in Senate Republicans' Latest Tax Proposal

by Baker Donelson on

After dominating the agenda for most of 2017, the Affordable Care Act (ACA) seemed to take a backseat at first as Republicans shifted their focus to enacting tax legislation. The initial momentum behind the bipartisan...more

Recent Case Highlights Risks of Paying Physicians for Routine Duties - Signed writing required, informal documentation may not be...

by Stinson Leonard Street on

Payments to physicians, even for routine, necessary duties, may cause referrals to the entity making the payments to be "prohibited referrals" under the Stark Law. This means the hospital or other entity should not have...more

Unreliable Expert Collapses DOJ-Led False Claims Act Case

by Holland & Knight LLP on

False Claims Act cases often turn into battles of the experts. But only rarely does that battle turn into a rout. It did last week in a case out of the Eastern District of Virginia, United States ex rel. Ribik v. HCR...more

K&L Gates Triage: 340B Update: CMS Finalizes 340B Program Reimbursement Cut on Part B Drugs

by K&L Gates LLP on

In this episode, Richard Church and Ryan Severson discuss the recent decision by the Centers for Medicare and Medicaid Services (CMS) to substantially decrease reimbursement under the Outpatient Prospective Payment System...more

CMS Finalizes Medicare Physician Fee Schedule Update for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published its final Medicare physician fee schedule (PFS) rule for CY 2018. In addition to updating rates for 2018, the rule includes important policy changes, including...more

CMS Finalizes Medicare OPPS, ASC Rates and Policies for CY 2018

by Reed Smith on

CMS has published a final rule updating Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2018. In addition to rate...more

ACA Risk Corridors Update: Trump Administration Releases 2016 Amounts, Paving the Way for Litigation Over Amounts Owed

by Faegre Baker Daniels on

On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its Risk Corridors payment and charge amounts for the 2016 benefit year. This event is significant in that it both acknowledges and quantifies...more

CMS Releases Final OPPS Rule: Removes Total Knee Replacements from IOP List; Adds Three New ASC Eligible Procedures

On November 6, 2017, CMS published its final rule for the 2018 Outpatient Prospective Payment System (OPPS). The changes will go into effect January 1, 2018. Among other changes, the rule will allow Medicare payment for...more

2018 Updates to the MACRA Quality Payment Program

On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule with Comment updating the Quality Payment Program (QPP) under the Medicare and CHIP Reauthorization Act of 2015 (MACRA)....more

States May Be Looking to Balance Budgets on the Backs of Medicaid Health Plan Reserves

by Alston & Bird on

As state governments look for ways to cover their budgetary shortfalls, Medicaid managed care organizations (MCOs) are an attractive target for cash-strapped states because many MCOs have accumulated “Medicaid savings”...more

“We’re Listening” – CMS Issues Final Rule For Year 2 Of The Quality Payment Program And Highlights Efforts To Continue...

by Pierce Atwood LLP on

On November 2, 2017, CMS issued the final rule with comment for the second year (2018) of the Quality Payment Program as well as an interim final rule. Continuing with its theme of a CMS that is “listening to feedback,” CMS...more

Year 2 in the QPP: A Regulatory Update

by Polsinelli on

On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Quality Payment Program (QPP) Final Rule. The Final Rule contains notable changes that may affect smaller practices participating in...more

Changes to California’s Document Retention Policy

by King & Spalding on

Medi-Cal and other California health care providers will soon be required to change their document retention policies and practices for services rendered under programs administered by California’s Department of Health Care...more

Final Home Health Rule Drops Controversial Proposed Payment Model

by Bass, Berry & Sims PLC on

Last week, home health agencies welcomed the Centers for Medicare & Medicaid Services' (CMS) decision to drop a controversial proposed payment model and leave largely unchanged the current payment system. Responding to...more

Capitol Hill Healthcare Update

by BakerHostetler on

The year-end schedules of the Senate HELP and Finance committees just became more clogged, as the two panels will lead the review of President Trump’s nominee to be Health & Human Services (HHS) secretary. Trump announced...more

Top Takeaways for Medicare Physician and Hospital Payments in 2018

by Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2017, released the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Final Rule for...more

Window on Washington - Vol. 1, Issue 34

by Clark Hill PLC on

Short-term Continuing Resolution Likely Needed to Fund Government Past December Deadline: Republicans are focused on tax reform through Thanksgiving, and when lawmakers return from the upcoming holiday recess, they will have...more

The Impact of 2018 Medicare Reimbursement Rates on Providing Dialysis Vascular Access in VAC or OBL Versus ASC Settings

by McGuireWoods LLP on

Earlier this month, the Centers for Medicare and Medicaid Services issued the 2018 Medicare Physician Fee Schedule and Ambulatory Surgical Center Fee Schedule, which included updates to payment policies, payment rates and...more

CMS Finalizes Reimbursement Cuts for 340B Hospitals

by Foley & Lardner LLP on

In a striking blow to 340B hospitals, the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) released a final Medicare Outpatient Prospective Payment System (OPPS) rule adopting its...more

CMS Announces New Policy for Biosimilars Payments Under Part B

by Goodwin on

As we previously reported, the Centers for Medicare and Medicaid Services (“CMS”) has been considering comments on a proposed rule regarding biosimilar payment policies. On Thursday, CMS issued a final rule for the 2018...more

Healthcare restructurings: four key issues to consider before a chapter 11 filing

by DLA Piper on

A growing number of healthcare companies are facing financial challenges. Among these challenges are the ever-changing regulatory environment, enhanced government scrutiny, increased competition, reimbursement changes and...more

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