The CMS Interoperability and Prior Authorization Rules
Podcast — Drug Pricing: How Are Payers Responding to the IRA?
Findings from Gibbins’ Annual Healthcare Bankruptcy Report
A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration
Video: Braidwood v. Becerra – Challenging the Affordable Care Act’s Preventive Services Coverage Provision – Thought Leaders in Health Law
Hospice and Home Health Survey Perspectives: A Conversation with Kim Skehan, VP of Accreditation at CHAP
Transparency and the Open Payments Program
Taking the Pulse, A Health Care and Life Sciences Video Podcast | Episode 173: Improving rural health care with Dr. Kevin Bennett, the Director of the Research Center for Transforming Health and the
Counsel That Cares - The Private Payer's Perspective on Value-Based Care
Podcast: Health Equity – Behind the Buzzwords – Diagnosing Health Care
A Very “Special” Episode: Amid Controversy, CMS Launches the Hospice Special Focus Program
Grace from CMS: Unexpected Good News on HIS and CAHPS Appeals
This Bandwagon Has a Broken Wheel: OIG Joins the Inconsistent Approach to Hospice GIP Claims
Behind the Curtain: Enhanced Provider Enrollment Oversight
Survey Woes: CMS Ramps Up Hospice Survey Program and Consequences
Inflation Reduction Act’s Drug Price Negotiation Provisions – What Now? – Diagnosing Health Care Podcast
A Glimpse Into the Other Side: Understanding the Perspective of Government Enforcers
I Understood There Would Be No Math: Audits, Extrapolations, and a New Set of Rules
Podcast: Inflation Reduction Act’s Drug Price Negotiation Provisions – What’s Next? - Diagnosing Health Care
Quick Takeaways From the 2024 Proposed Hospice Wage Index Rule
On August 12, 2024, OIG announced the results of an audit of payments made to hospitals for inpatient claims with the Medicare Severity Diagnosis-Related Groups (MS-DRGs) that require ninety-six hours of consecutive...more
On July 31, 2024, CMS published a final rule updating the Medicare rates and policies applicable to inpatient rehabilitation facilities (IRFs) under the IRF Prospective Payment System (PPS) and the IRF Quality Reporting...more
Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more
On March 29, 2024, CMS published its fiscal year (FY) 2025 prospective payment system (PPS) proposed rule for inpatient rehabilitation facilities (IRFs). Comments are due by 5 pm ET on May 28, 2024. In the IRF PPS proposed...more
On July 27, 2023, CMS issued a final rule updating Medicare payments and policies under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program for FY 2024 (Final IRF...more
The House and Senate were both in session this week, with healthcare activity at the committee level. The House Ways and Means Committee held a markup focused on healthcare transparency and consolidation legislation. The...more
On June 27, 2023, CMS hosted a Special Open Door Forum regarding its Review Choice Demonstration program for Inpatient Rehabilitation Facility Services (IRFs). CMS has stated that the Medicare IRF benefit continues to...more
On April 4, 2023, CMS issued proposed rules for Fiscal Year (FY) 2024 to update Medicare payment policies for skilled nursing facilities (SNFs) and inpatient psychiatric facilities (IPFs). CMS notes these rules are intended...more
On April 3-4, Centers for Medicare & Medicaid Services (CMS) issued a number of proposed rules that would materially impact reimbursement rates for skilled nursing facilities (SNFs), inpatient psychiatric facilities (IPFs)...more
This month, OIG updated its work plan to include a new Inpatient Rehabilitation Facility (IRF) Nationwide Audit. In explaining the new workstream, OIG cited high IRF error rates in other reviews and plans to determine whether...more
On July 27, 2022, CMS issued final rules for FY 2023 in its yearly update to Medicare payment policies and rates under the Inpatient Rehabilitation Facilities (IRFs) prospective payment system (PPS) and the Inpatient...more
On November 2, 2021, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year (CY) 2022; makes significant changes to the provider...more
Skilled Nursing Facilities in particular and to a lesser extent other types of Residential Care Facilities, including Assisted Living Facilities and Behavioral Health Facilities, have always been under the government’s...more
Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in healthcare regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and...more
CMS's final FY 2021 inpatient rehabilitation facility (IRF) prospective payment system rule went into effect for discharges occurring on or after October 1, 2020. The rule amends certain coverage and documentation...more
As noted in our March 31, 2020 blog article, “Strategies in Responding to COVID-19: Expanding Scope of Practice to Increase Patient Access to Healthcare” and in our May 8, 2020 blog article, “COVID-19: Medical Liability for...more
Caring for Recipients, Protecting the Workforce and Supporting Provider Sustainability - Examine the Immediate Issues and Opportunities Facing Long-Term Care Providers—and Look Ahead at How to Build a Stronger Future—at a...more
Last week CMS issued a new round of regulatory waivers and rule changes in response to the COVID-19 public health emergency, including its Interim Final Rule with comment period, CMS-5531-IFC. The key changes relax certain...more
As part of sweeping exemptions aimed at facilitating all levels of healthcare during the coronavirus public health emergency, the Centers for Medicare and Medicaid Services (CMS) has been issuing waivers for a wide range of...more
The Centers for Medicare and Medicaid Services (CMS) made a number of recent changes to expand the Settlement Conference Facilitation (SCF) process for providers and suppliers mired in the backlog of appeals at the...more
In the wake of its recent efforts to settle claims (see the 2014 initial hospital inpatient settlement and the 2016 second-round wave), in the heavily backlogged Medicare administrative appeals system, CMS has introduced a...more
On June 17, 2019, CMS announced a voluntary settlement program for Inpatient Rehabilitation Facility (IRF) appeals pending at the Medicare Administrative Contractor (MAC), the Qualified Independent Contractor, the Office of...more
Well, it’s a start. New Medicare rules kicked in starting January 1, 2019 that are aimed at focusing less provider time on paperwork and more on patient care in inpatient rehabilitation facilities. Any change that reduces...more
Editor’s Note: Inpatient psychiatric facilities operate under a heavy burden of federal regulatory requirements. In a new report commissioned by the National Association of Behavioral Health (NABH), summarized below, Manatt...more
CMS released the Fiscal Year 2020 proposed rule (the Proposed Rule) outlining new Medicare policy and payment changes for inpatient rehabilitation facilities (IRFs) last Wednesday. The Proposed Rule proposes updating IRF...more