In what is already a highly regulated industry, it is becoming increasingly difficult for healthcare organizations to navigate the growing volume, complexity and enforcement of laws, regulations and guidance that surround...more
The litigator’s adage “it’s easy to plead, it’s hard to prove” once again came true in the long-running False Claims Act (FCA) case targeting Medicare Advantage (“MA”) plans operated by UnitedHealth (United). Eight years...more
McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. Click here to subscribe to future blog posts. September 19, 2024 – Comments on the calendar year (CY) 2025 physician fee...more
Although most health care lawyers and compliance officers who review and analyze physician compensation understand that fair market value (FMV) is important, the nuances around FMV are sometimes missed....more
Are you in a clinical setting and looking for updates on compliance trends and initiatives? Join us this October for HCCA’s Virtual Clinical Practice Compliance Conference and get insights, updates, and strategies for...more
The Centers for Medicare & Medicaid Services (CMS) on April 10, 2024, released a proposed rule for the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System...more
Effective December 21, 2023, the Centers for Medicare & Medicaid Services (CMS) has directed A/B MACs to not make downward adjustments to claims for CPT Codes for complex therapy administration (96401-96549) based solely on...more
A federal judge recently exposed weaknesses in the U.S. Department of Justice's (DOJ) criminal healthcare fraud enforcement efforts by vacating a jury's conviction of a prominent Maryland doctor. On Aug. 4, 2023, a federal...more
The CPT® Editorial Panel met in New Orleans, Louisiana, from September 21 to 23, 2023 to consider proposals to create new current procedural terminology (CPT) codes and to revise or delete existing codes. The resulting...more
Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: • Healthcare Co.’s Coding Error Allegedly PHI-cilitates...more
A bipartisan coalition of 33 AGs settled with health care clearinghouse Inmediata Health Group, LLC and an affiliated entity (collectively, Inmediata) to resolve allegations that Inmediata violated state consumer protection...more
Learning Objectives - Review Proposed Changes for Medicare Advantage Plans in 2024 - Discuss the change from Version 24 to Version 28 and the impact on Risk Adjustment Calculation Methodology - Explain how...more
On March 31, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced the finalized capitation rates and payment policies for the 2024 Medicare...more
The American Conference Institute is hosting the 21st Annual Rx Drug Pricing Boot Camp in New York. With both federal and state law makers engaging in greater scrutiny of prescription drug pricing, now is the time when...more
A recent article in Part B News, “Be careful about upcoding; DOJ may come after it as a false claim,” discussed how the U.S. Department of Justice frequently prosecutes improper billing of CPT codes for Medicare patients. ...more
For over two and a half decades, the Compliance Institute (CI), has been HCCA’s primary educational and networking event for healthcare compliance professionals, offering attendees the latest in real-world compliance issues,...more
CT magazine (August 2022) - Medical school curriculum is heavy in anatomy, physiology, biochemistry, pathology, and clinical rotations or clerkships. There is very little, if any, instruction on proper coding and billing...more
The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (PFS) Proposed Rule on July 7, 2022, which impacts Medicare Part B payments starting Jan. 1,...more
Looking for updates on government initiatives related to physicians, clinics, and physician integrity trends? Join us this October for HCCA’s Virtual Clinical Practice Compliance Conference and get insights, updates, and...more
According to hospital officials in multiple states, Anthem Blue Cross is behind on billions of dollars in payments to hospitals because of new reimbursement rules, computer problems, and mishandled claims—this according to an...more
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
The Department of Justice (DOJ) continues to concentrate on risk adjustment programs of payers with Medicare Advantage Organizations (MAO) as a prime enforcement target. One particular area of focus, both civilly and...more
Report on Medicare Compliance 30, no. 17 (May 3, 2021) - With the pandemic in its second year, coding and documentation of long-haul COVID-19 patients who are admitted or readmitted to the hospital may be a sleeper risk....more
Learning objectives: - Governmental/Payor Data Analytics - Impact of Yates Memo and Data Analytics - COVID-19 Evaluation and Management Coding and Documentation - COVID-19 Testing Coding and Documentation -...more
Our Virtual Regional Healthcare Compliance Conferences provide updates on the latest news in regulatory requirement, compliance enforcement, and strategies to develop effective compliance programs. Watch, listen, and ask...more