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Jenner & Block

Government Contracts Legal Round-Up - April 2023 Issue 6

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Legislative Update - Defense Federal Acquisition Regulation Supplement: Use of Supplier Performance Risk System (SPRS) Assessments (DFARS Case 2019–D009) DoD issued a final rule amending the DFARS to update the policy...more

Greenbaum, Rowe, Smith & Davis LLP

Governor Murphy Signs Executive Order Setting COVID-19 Vaccination and Booster Shot Requirements for New Jersey Healthcare Workers

What You Should Know •Governor Murphy recently signed an Executive Order requiring healthcare providers and others working in New Jersey healthcare settings to be fully vaccinated against COVID-19 by specific dates...more

Bass, Berry & Sims PLC

CMS Advisory Opinion Provides Flexibility Under Stark for Group Practice Structures Involving Wholly-Owned Physician Practice...

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The Centers for Medicare & Medicaid Services (CMS) recently issued Advisory Opinion No. CMS-AO-2021-01, clarifying that physician groups that furnish designated health services (e.g., laboratory, imaging) through wholly-owned...more

Husch Blackwell LLP

COVID-19: CMS Green Lights Contractors To Restart Hospice Medical Reviews

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Medical reviews to restart- The Centers for Medicare & Medicaid Services (CMS) medical review activity suspended due to COVID-19 is set to restart on August 3, 2020, regardless of the public health emergency status....more

King & Spalding

GAO Concludes CMS Should Increase Oversight of Post-Payment Claims Review Process

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The Government Accountability Office (GAO) has released the findings of its study of the steps taken by CMS to prevent Medicare contractors from conducting certain duplicative post-payment claims reviews. Based on its audit,...more

Baker Donelson

New Federal Health Care Facility Regulations Could Mean More Construction Work

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On April 16, 2014, the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, published proposed rules that would amend the fire safety standards for hospitals,...more

Faegre Drinker Biddle & Reath LLP

Brace Yourself: The RACs Are Back

Under the controversial program private contractors audit hospitals and other Medicare providers for fraudulent and erroneous Medicare billing. Why is it controversial? Because the auditors are paid a percentage of...more

McAfee & Taft

CMS authorizes contractors to deny ‘related’ claims of physicians who are not undergoing review

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The Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services recently issued Transmittal 505 modifying Section 3.2.3 of the Medicare Program Integrity Manual. CMS employs a variety of...more

King & Spalding

CMS Provides MACs, RACs, and ZPICs With Automatic Denial Authority for “Related” Claims

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Effective March 6, 2014, Medicare contractors may automatically deny claims that are “related” to other claims that have been denied as a result of pre- or postpayment review. Contractors need not issue Additional...more

King & Spalding

CMS Instructs Contractors Not to Conduct Patient Status Reviews for Claims with Dates of Admission Through December 31, 2013

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On November 15, 2013, CMS issued Transmittal 1315, a One-Time Notification (CMS Transmittal), instructing Medicare Administrative Contractors (MACs), Recovery Auditors and the Supplemental Medical Review Contractor not to...more

Foley & Lardner LLP

GAO Report on Medicare Contractors

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On August 22, the U.S. Government Accountability Office (GAO) released a report calling for the Centers for Medicare & Medicaid Services (CMS) to improve the efficiency and effectiveness of its Medicare program integrity...more

King & Spalding

GAO Calls For Consistency Among Medicare Contractors Postpayment Claims Review

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The U.S. Government Accountability Office (GAO) recently published the results of a study examining the effectiveness of CMS’s contractors that conduct postpayment claims reviews to identify improper payments (i.e., Medicare...more

King & Spalding

CMS Updates Policies and Procedures for National Coverage Determinations and Announces a New Expedited Process for Removing...

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On August 7, 2013, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register1 a notice that updated the processes that CMS uses for opening, deciding or reconsidering National Coverage...more

Baker Donelson

CMS's Use of Contractors to Determine "Sustained or High Level of Payment Errors" Upheld

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In a decision handed down on July 23, 2013, the United States Court of Appeals for the D.C. Circuit upheld the use by CMS of outside contractors to determine whether a home health agency’s reimbursement claims had exhibited a...more

King & Spalding

CMS Announces New Unified Program Integrity Contractors

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CMS recently announced plans to implement a new Medicare and Medicaid program integrity contractor, Unified Program Integrity Contractors (UPICs). ...more

Poyner Spruill LLP

Shorts on Long Term Care - June 2013

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In this issue: - What’s Up With Nursing Facility “Mandatory” Corporate Compliance Programs? - Updated OIG Exclusion Guidance Spells Out Recommended Employee Screening Procedures - General Assembly Calls...more

King & Spalding

Available Recording of Roundtable on CMS Ruling 1455-R and Proposed Rule on Part B Rebilling Issues

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King & Spalding recently hosted a Roundtable Webinar focused on CMS Ruling 1455-R and Proposed Rule 1455-P. Both of these developments are of great interest to the healthcare industry because they have a significant impact on...more

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