News & Analysis as of

Healthcare Facilities Medicare

Off-campus provider-based hospital outpatient departments: Challenges and options in 2018

by Bricker & Eckler LLP on

2017 was another challenging year for hospitals grappling with site-neutral payment changes for off-campus provider-based hospital outpatient departments (OCPBDs). ...more

Tax Reform Changes to Healthcare

by Holland & Knight LLP on

Following a final vote in the U.S. House of Representatives on Wednesday morning, Dec. 20, 2017, Congress sent the Tax Cuts and Jobs Act (H.R. 1) to President Donald Trump's desk. In addition to extensive revisions to the tax...more

The 340B Drug Pricing Program: New CMS Final Rule Draws a Motion for Preliminary Injunction from Hospital Groups

On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the final rule, “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting...more

As Medicare Audit Season Approaches, an Update on the Appeals Backlog

The federal government recently awarded new contracts for Medicare recovery audits, and recovery audit contractors (“RACs”) will start showing up at hospitals, home health providers, and other facilities any time. But this...more

Will the Massachusetts Proposed Legislation on Hospital Outpatient Facility Fees Have a Nationwide Impact?

by Foley & Lardner LLP on

In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes...more

Will CMS Consider Your Institution to Be a Hospital? Guidance on the "Primarily Engaged In" Standard

by Baker Ober Health Law on

Recent guidance from CMS suggests that some hospitals, and particularly specialty hospitals that provide mostly outpatient care, may soon find themselves the focus of surveyors' scrutiny. In early September, CMS issued...more

CMS Memorandum Requires Legionella Risk Reduction in Healthcare Facilities

by Holland & Knight LLP on

According to a recent review of Legionnaires' disease outbreaks, 34 percent were associated with long-term care facilities and hospitals. Patients at risk of contracting Legionnaires' disease include smokers, those with...more

CMS Corrects Final FY 2018 IPPS, LTCH, and SNF Payment Rules

by Reed Smith on

CMS has released corrections to two major fiscal year (FY) 2018 Medicare payment rules. First, CMS has made numerous technical corrections to the FY 2018 inpatient prospective payment systems (IPPS) and long term care...more

CMS Unexpectedly Withdraws Three Proposed Rules

The Centers for Medicare and Medicaid Services (CMS) recently announced the withdrawal of three proposed rules that, in one case, had been pending since 2014. The first proposed rule that CMS decided to scrap was proposed in...more

Tennessee CON Report

I. August 2017—Tennessee Certificate of Need Meeting - The agency approved the following applications during the August 23 meeting. A. Consent Agenda - 1. Vanderbilt University Medical Center, Nashville (Davidson...more

What Exactly Is a Hospital, Anyway? CMS Issues Guidance on “Primarily Engaged” Medicare Certification Requirement

The rules that govern participation in the Medicare program are notoriously voluminous and complex. Indeed, courts have described them as akin to a “[body of] law written by James Joyce and edited by E.E. Cummings” and “among...more

CMS Proposes to Reduce Facility Payment for Non-Excepted Provider-Based Outpatient Department Services by 50 Percent

by Baker Ober Health Law on

CMS recently proposed to reduce the facility fee for non-excepted off-campus provider-based hospital departments (OPBDs) from 50 percent of the Medicare Physician Fee Schedule (MPFS) amount to 25 percent of the MPFS amount....more

Medicare Fraud Strike Force Strikes Again – in a Big Way

The Medicare Fraud Strike Force initiated its largest ever healthcare enforcement action, charging 412 defendants in July 2017 with approximately $1.3 billion in fraudulent claims. The Strike Force consists of teams that...more

Health Care E-Note - July 2017

by Burr & Forman on

Everywhere you look these days, there seems to be another report of a cyberattack -- attacks which do not discriminate based on industry type, size of business, or impact. In other words, everyone is vulnerable. In fact, the...more

Key funding issues for provider-operated allied health residency programs

by Dentons on

Medicare GME reimbursement is designed only to support the training of medical, dental and podiatric residents. The Medicare program does, however, provide separate funding to support certain programs that train nursing and...more

Court Puts the Brakes on Whistleblower's FCA Parking Claims

by Baker Ober Health Law on

The Department of Justice (DOJ) reports that, in fiscal year 2016 ending September 30, it obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims. More than half of this...more

The Opportunities and Challenges of Freestanding Emergency Departments

Following our blog post regarding the retail clinic movement, “Patient Check-Ups Before Checking Out: Partnering to Bring Health Care into the ‘One-Stop Shopping’ Sector” (April 19, 2017), we continue our examination of...more

FCA Issues to Watch: FCA Claims Concerning Physician Compensation

by Bass, Berry & Sims PLC on

Physician employment arrangements with hospitals have remained a significant area of regulatory scrutiny in recent months with the announcement of several high profile settlements and decisions in key FCA cases involving...more

Tennessee Health Services and Facilities Report: April 2017 Newsletter

by Burr & Forman on

The Tennessee Health Services and Development Agency (“HSDA”) is responsible for regulating the health care industry in Tennessee through the Certificate of Need Program. A Certificate of Need (“CON”) is a permit for the...more

Health Care E-Note - March 2017

by Burr & Forman on

Like pain clinics and pharmacies, practitioners treating substance use disorder appear to be a target for federal enforcers. Under President Trump's administration and Alabama Attorney General Steve Marshall, law enforcement...more

Tennessee Health Services and Facilities Report: January 2017 Newsletter

by Burr & Forman on

The Tennessee Health Services and Development Agency ("HSDA") is responsible for regulating the health care industry in Tennessee through the Certificate of Need Program. A Certificate of Need ("CON") is a permit for the...more

2017 Physician Fee Schedule Includes Clarification of Space and Equipment Rental Exception Under Stark Law

by Roetzel & Andress on

The Department of Health and Human Services Center for Medicaid and Medicaid Services (“CMS”) recently finalized the Calendar Year 2017 Physician Fee Schedule (“2017 Fee Schedule”), which includes a restatement of a provision...more

Site-Neutral Billing Exemptions

by Faegre Baker Daniels on

The Balanced Budget Bill Act of 2015 has a site-neutral billing provision relating to off-campus hospital outpatient departments (HOPDs). Those are facilities away from the hospital campus but certified as part of the...more

CMS Finalizes Updated Fire Safety Standards for Health Care Facilities

by Reed Smith on

On May 4, 2016, CMS is publishing a final rule amending fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term...more

CMS Proposes Update to Medicare IRF PPS Payments for FY 2017

by Reed Smith on

CMS has published its proposed rule to update Medicare prospective payment system (PPS) rates for inpatient rehabilitation facilities (IRFs) for FY 2017, which begins October 1, 2016. CMS estimates that rates would increase...more

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