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Medicare Program Integrity Manual (MPIM)

Baker Donelson

CMS Finalizes Regulatory Definition of Medically "Reasonable and Necessary"

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On January 14, 2021, CMS finalized a regulatory definition for determining whether an item or service is "reasonable and necessary" for Medicare coverage purposes. Medicare Program; Medicare Coverage of Innovative Technology...more

King & Spalding

CMS Proposes to Codify the Definition of “Reasonable and Necessary” and to Establish a New Medicare Coverage Pathway

King & Spalding on

On September 1, 2020, CMS published a proposed rule that would define “reasonable and necessary” for purposes of coverage under Part A and Part B of the Medicare program, and that would establish a new expedited Medicare...more

Hogan Lovells

CMS proposes “reasonable and necessary” definition, expedited breakthrough device coverage process

Hogan Lovells on

On Tuesday, September 1, 2020, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule addressing the Medicare coverage standard and expedited coverage for certain medical devices. If finalized, the...more

Health Care Compliance Association (HCCA)

CMS Settles Enrollment Case About Retroactive Billing Over 30 Days

Report on Medicare Compliance 29, no. 2 (January 20, 2020) -  CMS has agreed to pay a physical therapy practice $55,000 in a December settlement that’s at the intersection of claims and enrollment, and again runs into the...more

Baker Donelson

Adverse Action Reporting – Avoid Medicare Enrollment Denial or Revocation

Baker Donelson on

CMS revised its policy guidance regarding adverse action reporting requirements once again in the Medicare Program Integrity Manual (MPIM) Transmittal 865. This guidance is arguably inconsistent with the regulations and with...more

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