The U.S. Small Business Administration (SBA) on Aug. 23, 2024, issued a Proposed Rule that significantly changes the effect of recertifications of size and socioeconomic status under set-aside contracts following a merger or...more
On August 7, 2024, the Centers for Medicare & Medicaid Services (“CMS” or the “Agency”) issued a final procedural notice (“Notice”) outlining a new Medicare coverage pathway, aimed at achieving timelier and predictable access...more
The Centers for Medicare & Medicaid Services (CMS) issued the final procedural notice on Transitional Coverage for Emerging Technologies (TCET), effective as of August 12, 2024. TCET is a new pathway that uses existing...more
Obtaining Medicare coverage and reimbursement for medical devices is notoriously more difficult than for drugs or biologics, and any progress on expanding coverage pathways has been agonizingly slow for industry stakeholders....more
On July 26, 2024, CMS issued Change Request (CR) No. 13413 providing instructions and timelines for Medicare Administrative Contractors (MACs) for the processing of SSI realignment requests for cost reporting periods before...more
In the proposed CY 2025 Physician Fee Schedule (PFS) published in the Federal Register on July 31, the Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposal to revise the Medicare Claims...more
On June 28, 2024, SCOTUS overturned the long-standing Chevron doctrine in its decision Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce. The Court’s ruling will have a significant impact on...more
Today marks one month since United Health Group’s (UHG) Change Healthcare reported that it had been hit by a cybersecurity attack. The attack has caused a major disruption to the US healthcare system, significantly impacting...more
Change Healthcare Cyberattack - On February 21, 2024, Change Healthcare—a healthcare technology company owned by UnitedHealth Group—issued a statement that it had been impacted by a ransomware attack. According to Change...more
On February 21, 2024, CMS published a transmittal on its website with instructions for Medicare Administrative Contractors (MACs) to implement CMS’s final rule, issued June 9, 2023, concerning the treatment of the Part C days...more
House Energy and Commerce Health Subcommittee Holds Legislative Hearing on 19 Bills. Lawmakers discussed 19 pieces of legislation designed to support patients and caregivers in the key areas of autism, heart defects,...more
Congress is on its way to extending the stop-gap funding bills into March (and may have already done so by the time you read this). Absent from the legislation to continue funding the federal government is a “doc fix” that...more
Karthik Consulting, LLC v. United States, Case No. 23-944, a recent Court of Federal Claims case, identifies an essential nuance in determining the eligibility of contractors who have graduated from the Small Business...more
On July 10, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that would (i) include hospices in the 36-month rule ownership transfer restrictions that currently exist for home...more
The Centers for Medicare & Medicaid Services (CMS) recently issued a long-awaited Notice with Comment Period outlining a proposed Transitional Coverage for Emerging Technologies (TCET) pathway under Medicare that would be...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
With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% in 2021), the Centers for Medicare and Medicaid...more
On May 19, 2023, Novitas Solutions and First Coast Options sent an email to certain interested parties, with whom they had engaged following the multijurisdictional contractor advisory committee (CAC) meeting explaining that...more
In what passes for neon lights in the regulatory world, CMS said Medicare Advantage (MA) plans must follow the two-midnight rule, its case-by-case exception and the inpatient-only (IPO) list, according to the final 2024 rule...more
Editor’s Note: We are excited to announce that this article is the first of a series addressing Medicare Part B’s “incident to” billing requirements, designed to give practical guidance and orientation to health care...more
Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more
This month, OIG published its findings relating to its audit on providers who sought reimbursement from Medicare for bad debts. OIG conducted the audit to confirm whether: (a) providers complied with Federal requirements...more
On December 19, 2022, the U.S. Government Accountability Office (GAO) released a report titled, “Medicare: CMS Needs to Address Risks Posed by Provider Enrollment Waivers and Flexibilities” (GAO-23-105494). The report...more
The initial article on this subject discussed generally why Medicare providers need to understand the Medicare administrative appeals process, especially in connection with overpayment determinations, Additional Documentation...more
With many hospitals well into their FY 2021 Medicare cost report preparation, here is a brief reminder of the process required for protesting items, as well as a summary of two new developments for Medicare Graduate Medical...more