News & Analysis as of

Health Care Providers Medicare

CMS Releases 2018 HCPCS Update

by Reed Smith on

The 2018 update to the alphanumeric Healthcare Common Procedure Coding System (HCPCS) files is now available on the CMS website. The files include the Level II alphanumeric HCPCS procedure and modifier codes, their long and...more

Hospitals & Physician Organizations Summary Report - November 2017

by Benesch on

Uncertainty and pressures continue to mount for healthcare providers, creating a new operating environment – Uncertainty around Medicaid and other programs, the shift to value-based care, margin pressures, the need to search...more

CMS Releases Broad-Ranging Medicare Advantage and Part D Proposed Rule

by McDermott Will & Emery on

CMS released a broad-ranging proposed rule for the Medicare Advantage and Part D Programs on Thursday, November 16, 2017. The proposed rule addresses a broad and diverse range of MA and Part D regulatory requirements,...more

New Home Health Rules Effective in January 2018—Some Traps for the Unwary

The Centers for Medicare & Medicaid Services (CMS) have issued new Conditions of Participation (CoP) for home health agencies (HHA) that are effective January 13, 2018. The CoP were originally scheduled to take effect on...more

CMS Updates End-Stage Renal Disease Prospective Payment System

by McGuireWoods LLP on

On Nov. 1, 2017, the Centers for Medicare & Medicaid Services (CMS) published a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis...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

Skilled Nursing Facilities Targeted in Government Enforcement Actions and Qui Tam Lawsuits

by Pepper Hamilton LLP on

Skilled nursing facilities (SNFs) have been the subject of multiple high-profile False Claims Act settlements in recent years, and new pronouncements and pending enforcement actions suggest that SNFs will continue to face...more

The Case of the Bashful Whistleblower

by Faegre Baker Daniels on

William Nash filed a whistleblower case against his former employer but wanted to remain anonymous so that his new employer wouldn’t know that he is—you guessed it–a whistleblower. William’s qui tam action alleged Medicaid...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

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

“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

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

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

Chemed Settles Largest Hospice FCA Suit for $75 Million

by King & Spalding on

On October 30, 2017, Chemed and several of its subsidiaries, including Vitas Hospice Services LLC and Vitas Healthcare Corporation (Vitas), entered into a $75 million settlement to resolve allegations that Vitas submitted...more

FCA Settlement Alert: Physician Compliance with CMS’ 60-Day Overpayment Rule

by Williams Mullen on

On October 13, 2017, the U.S. Attorney’s Office for the Middle District of Florida announced a settlement for over $440,000 with First Coast Cardiovascular Institute, P.A. (“First Coast”), a large cardiovascular physician...more

CMS Finalizes Changes in CY 2018 OPPS and PFS Final Rules

by K&L Gates LLP on

On November 1, 2017, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule with comment period revising the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory...more

Health Care Newsmakers: Steve McCoy, Vice President/General Counsel, Patient First

by Williams Mullen on

With all the discussion lately about trying to manage the cost of healthcare, what are the most important recent changes in reimbursement methodology and strategies which Patient First has seen in the market? The ongoing...more

DOJ Settles Second 60-Day Overpayment Case, Highlights Broader Reach of the FCA’s Reverse False Claims Provision

by Reed Smith on

A recent False Claims Act (“FCA”) settlement involving an allegedly overpaid Florida medical practice reaffirms the interplay between the 60-Day Overpayment Statute and the FCA, but also highlights the importance for all...more

Telemedicine on the Rise: Increased Deployment by Veterans Administration, MACRA, Plus Potential Expansion Under Legislative...

Telemedicine has the potential to disrupt the health care delivery system by providing access to care at a lower cost than face-to-face visits. Telemedicine incorporates remote communications into the provision of health care...more

CMS Boosting Medicare ESRD Facility Payments by 0.5% for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has issued its final Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates and policies for calendar year 2018. CMS projects that the final rule will...more

"Insider" Edition—Required Referrals and the Stark Law (Part One of Two)

When a hospital is putting together an employment contract with a physician, there are many items for both the hospital and the physician to consider. One question we have seen more and more hospitals ask is whether a...more

Most First-Phase ESCOs Achieved Success

by McGuireWoods LLP on

On October 13, the Centers for Medicare & Medicaid Services (CMS) announced results from the first performance year of the Comprehensive ESRD Care (CEC) Model. The CEC Model was designed by the Center for Medicare & Medicaid...more

CMS to Help SNFs Prepare for Value-Based Purchasing Program Rules (Nov. 16)

by Reed Smith on

A November 16, 2017 CMS call will focus on how the Medicare SNF Value-Based Purchasing Program will affect Medicare’s payments to SNFs beginning October 1, 2018. Among other things, the call will cover how CMS will translate...more

Learn What is New Regarding the Medicare Hospital “Primarily Engaged” Requirement (Nov. 2)

by Reed Smith on

CMS is hosting an educational call November 2, 2017 on new State Operations Manual guidance that discusses the Medicare definition of a hospital, including the requirement for hospitals to be primarily engaged in providing...more

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