News & Analysis as of

Inpatient Billing

Health Care Compliance Association (HCCA)

[Virtual Event] Clinical Practice Compliance Conference - October 12th - 13th, 8:50 am - 6:00 pm CDT

Get the latest updates on government initiatives related to physicians and clinics - HCCA’s Clinical Practice Compliance Conference provides insights, updates, and strategies that are pertinent to developing and managing...more

Holland & Knight LLP

CMS Releases CY 2022 OPPS and ASC Proposed Rule

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on July 19, 2021, released its calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed...more

FTI Consulting

The Two-Midnight Rule 2021 - Five Immediate Actions for Hospitals and Compliance Officers

FTI Consulting on

[co-author: Matthew Schwartz] In November of 2020, the HHS Office of Inspector General (OIG) announced it was resuming audits of inpatient (IP) claims with short lengths of stay and added the audits to its annual work plan...more

Epstein Becker & Green

New York State Department of Financial Services Summarizes Changes Relating to Administrative Denials, Prior Authorizations, and...

Epstein Becker & Green on

On March 10, 2021, the New York State Department of Financial Services (“DFS”) issued Insurance Circular Letter No. 4 (“Circular Letter”), which both explains modifications to the Insurance Law and the Public Health Law...more

Health Care Compliance Association (HCCA)

CMS offers correct billing tips for nonphysician outpatient services provided before or during inpatient stays

Compliance Today (March 2021) - The Centers for Medicare & Medicaid Services (CMS) has provided the following compliance notice: “In a recent report, the Office of Inspector General (OIG) determined that Medicare made...more

Benesch

Dialysis & Nephrology Digest - March 2021

Benesch on

Fresenius to defend itself from FCA suit following whistleblower allegations - A former employee alleges Fresenius engaged in arrangements with hospitals and nephrologists to ensure patient referrals to its dialysis...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

Robinson+Cole Health Law Diagnosis

CMS Updates and Revises COVID-19 FAQs on Medicare FFS Billing

On April 9 and 10, 2020, the Centers for Medicare and Medicaid Services (CMS) updated and revised their COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing....more

Health Care Compliance Association (HCCA)

Court Says Inpatients Changed to Observation Have Right to Appeal, Orders New Process

Report on Medicare Compliance 29, no. 12 (March 30, 2020) A federal court on March 24 ordered CMS to let Medicare patients “challenge decisions by hospitals” to change their status from inpatients to observation, dating...more

Troutman Pepper

Surprise Medical Bill Legislation: The Devil Is in the Details

Troutman Pepper on

Congress has been working for months to pass legislation protecting patients from surprise medical bills that arise when insured patients unknowingly receive out-of-network (OON) care, usually when receiving emergency medical...more

Hogan Lovells

FCA Alert: Decision Opens Door to Challenge of Agency Guidance in False Claims Cases

Hogan Lovells on

On November 5, 2019, the United States District Court for the Eastern District of Pennsylvania ruled on a motion to dismiss a False Claims Act (FCA) qui tam suit filed by the United States Department of Justice, long after it...more

Health Care Compliance Association (HCCA)

CMS Rules: Direct Supervision Is Gone, Prior Auth Is Here; Documentation Fix Has Limits

Report on Medicare Compliance 28, no. 40 (November 11, 2019) - CMS has given the green light to prior authorization for five types of procedures in an attempt to control “unnecessary increases” in these procedures as part...more

King & Spalding

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

King & Spalding on

Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more

Benesch

Skilled Nursing Facilities: Compliance with the Medicare 3-Day Billing Rule

Benesch on

The Office of Inspector General (OIG) recently released a report after identifying that Medicare had been improperly paying for Skilled Nursing Facility (SNF) care for beneficiaries who had not met the Medicare 3-Day...more

King & Spalding

Florida Hospitals Prevail in Litigation Challenging the Exclusion of Low Income Pool Days from the Medicare Disproportionate Share...

King & Spalding on

On July 23, 2019, Judge Rosemary Collyer of the United States District Court for the District of Columbia issued an opinion ruling in favor of ten Florida hospitals in their case challenging the calculation of their Medicare...more

Burr & Forman

Protecting Patients from “Surprise” Medical Bills

Burr & Forman on

Lawmakers in both the United States House and Senate are considering two proposals to address unexpected, patient medical bills from out-of-network providers. Often referred to as “surprise medical bills” or “balance...more

King & Spalding

CMS Issues Proposed Rulemaking for the FY 2020 Inpatient Psychiatric Facilities Prospective Payment System

King & Spalding on

The display copy of the proposed rulemaking for the FY 2020 Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) was posted on the Federal Register website last week (the Proposed Rule). The IPF PPS pays...more

Mintz - Health Care Viewpoints

Surprise Medical Bills Gain National Attention

No one wants to be faced with a large, unexpected medical bill after receiving health care services. Unfortunately, patients often find themselves in this situation after seeking emergency treatment or transportation,...more

Thompson Coburn LLP

Surprise billing legislation: What employers need to know

Thompson Coburn LLP on

In December 2011, my husband suffered a type of cardiac arrest, commonly referred to as a “widowmaker” heart attack. The good news is that he was one was the few individuals who survive such an attack. The bad news is that...more

King & Spalding

OIG Hospital Compliance Program Audit Claims $22 Million in Extrapolated Overpayments

King & Spalding on

A recent report issued by OIG finding an Indiana community hospital owed over $22 million in extrapolated overpayments carries some important lessons for hospitals audited under OIG’s hospital compliance program. As described...more

Troutman Pepper

Bipartisan Senate Group Leads Charge to Protect Consumers From 'Surprise Medical Bills'

Troutman Pepper on

In a departure from the otherwise stark division across party lines when it comes to health care, a new bipartisan effort has emerged to protect consumers from “surprise medical bills” for out-of-network charges. ...more

Robinson+Cole Health Law Diagnosis

CMS Revises Hospital Inpatient Admission Order Documentation Requirements

On August 17, 2018, the Centers for Medicare & Medicaid Services (CMS) published its Hospital Inpatient Prospective Payment Systems final rule for Fiscal Year 2019 (Final Rule). The Final Rule contains a number of important...more

Baker Ober Health Law

CMS Softens Physician Inpatient Order Documentation Requirement

Baker Ober Health Law on

Effective for hospital inpatient admissions on or after October 1, 2018, CMS has removed the requirement that a signed physician order must be present in the medical record to establish inpatient coverage. While this guidance...more

Mintz - Health Care Viewpoints

The OIG Identifies “Significant Vulnerabilities” in the Medicare Hospice Program: What This Might Mean for Hospice Providers?

Last week, the Department of Health and Human Services – Office of Inspector General (“OIG”) released a portfolio report identifying multiple vulnerabilities in the Medicare Hospice Program (the “Hospice Portfolio Report”),...more

Bricker & Eckler LLP

Health system to pay $18 million to settle FCA lawsuit

Bricker & Eckler LLP on

Banner Health has agreed to pay the federal government $18 million to resolve False Claims Act (FCA) allegations that the health system admitted patients who could have been treated less expensively on an outpatient basis....more

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Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

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Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

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