News & Analysis as of

Medicare

CMS Extends Medicare Prior Authorization Program for Repetitive Scheduled Non-Emergent Ambulance Transport

by Reed Smith on

CMS is extending for another year the Medicare prior authorization program for repetitive, scheduled non-emergent ambulance transport services rendered by ambulance providers in selected states. As previously reported, CMS...more

CMS Schedules Feb. 13 Town Hall Meeting on IPPS New Tech Applications

by Reed Smith on

On February 13, 2019, CMS is holding a public Town Hall meeting to discuss requests for add-on payments for new medical technologies under the Medicare hospital inpatient prospective payment system (IPPS). ...more

What's Next Now that Mandatory EPM and Cardiac Rehabilitation Payment Models Have Been Terminated?

by Baker Ober Health Law on

CMS released its Final Rule canceling the Episode Payment Model (EPM) and Cardiac Rehabilitation Incentive Payment Model (CR Incentive Payment Model). This was an expected result following August's proposed rule to cancel...more

Telehealth Opportunities Worth Watching in 2018

Continued physician shortages, reduced reimbursement from government and private insurance plans and the ever-increasing health care needs of an aging population are forcing payors and providers alike to increase the...more

House of Representatives reintroduces resident rotator legislation

by Dentons on

On December 5, members of the US House of Representatives reintroduced a bipartisan bill designed to help hospitals that accidentally established Medicare GME caps and/or per-resident amounts based on small numbers of...more

Medicare's Part B Premium Will Be Unchanged in 2018, But Many Will Pay More. Got That?

The announcement of the 2018 Medicare premium is good news for some beneficiaries and bad news for many others. The good news is that the standard monthly Part B premium, which about 30 percent of Medicare beneficiaries pay,...more

Holidays Come Early as CMS Proposes to Significantly Narrow Training Requirements Under Medicare Advantage and Part D Plan...

by Reed Smith on

A recent Centers for Medicare & Medicaid Services (CMS) proposed rule (the Proposed Rule) would mark the end of a heavily criticized and frequently revised compliance program training requirement currently imposed on Medicare...more

Telehealth Opportunities Worth Watching in 2018

by Pullman & Comley, LLC on

Continued physician shortages, reduced reimbursement from government and private insurance plans and the ever-increasing health care needs of an aging population are forcing payors and providers alike to increase the...more

What's New In Washington - December 2017

December is often the busiest time in Washington, and this year is no different as Congress races toward the holiday finish line. There is still a multitude of problems to solve before members can head back to their...more

Six Ways Tax Reform Could Change Healthcare

by Morgan Lewis on

Providers, including charitable hospitals, nonprofit organizations, and academic medical centers, should watch for possible policy changes in the tax reform bill reconciliation process....more

Final Senate Tax Bill Targets Health Care, Hospitals

by King & Spalding on

In the early hours of Saturday, December 2, 2017, the Senate approved its version of tax reform legislation, S. 1, the Tax Cuts and Jobs Act, by a vote of 51-49. All Republican Senators except Senator Bob Corker (R-TN)...more

Slow and Steady – CMS Expands Telehealth Reimbursement Opportunities in 2018

by McDermott Will & Emery on

The Centers for Medicare & Medicaid Services (CMS) reiterated its commitments to expanding access to telehealth services and paying “appropriately” for services that maximize technology in the Medicare Program; Revisions to...more

Telehealth Reaches Tipping Point – Now Included in OIG Audit Plan

by Tucker Arensberg, P.C. on

Telehealth has apparently reached the tipping point in its significance to the Medicare budget, because OIG has now announced that it will “review Medicare claims for telehealth services provided at distant sites that do not...more

Self-Administered Versions of Orencia and Cimzia Were Included In Calculating Medicare Part B Payment Costs Which Significantly...

by King & Spalding on

A report issued by the OIG on November 21, 2017 found that inclusion of the more costly self-administered versions of Orencia and Cimzia when calculating Medicare Part B costs caused Medicare and its beneficiaries to pay an...more

A “House of Cards”: DOJ Drops Out of ManorCare FCA Case After Judge Excludes Expert Witness

by Arnall Golden Gregory LLP on

The Department of Justice (DOJ) filed a motion on November 17, 2017 to voluntarily dismiss its False Claims Act (FCA) case against HCR ManorCare, Inc. (ManorCare). Despite a years-long investigation, coupled with nearly three...more

Legislation, Lawsuit Cloud Future of 340B Program Payment Rate Reductions

by Jones Day on

The Situation: A Final Rule published by the Centers for Medicare & Medicaid Services carries a provision that reduces reimbursement for most 340B Program drugs dispensed by disproportionate share hospitals and rural referral...more

Recent Congressional Actions Bring Drug Pricing Debate Back Into National Spotlight

by Holland & Knight LLP on

In late October, Sen. Bernie Sanders (I-VT) and Rep. Elijah Cummings (D-MD) introduced the Medicare Drug Price Negotiation Act of 2017 (S. 2011; H.R. 4138), which would allow the Department of Health and Human Services (HHS)...more

Health Care Weekly Preview from ML Strategies – December 2017

Following weekend passage of the Senate tax bill, we return this week with Congress needing to pass a government-spending bill. While it’s widely expected that this will be a two-week continuing resolution (CR), giving...more

Australian Competition & Consumer Law Update - November 2017

by Jones Day on

The Australian competition law environment has undergone some important changes of late. In this Update, we discuss the Australian Competition and Consumer Commission's ("ACCC") increasing focus on the unfair contracts...more

OIG Rescinds Advisory Opinion Due to Requestor’s Failure to Disclose Information

On November 28, 2017, the Office of Inspector General (OIG) rescinded advisory opinion 06-04, in which it had previously determined that a charity’s (Requestor) proposal to provide assistance to financially needy Medicare...more

Capitol Hill Healthcare Update

by BakerHostetler on

Congressional Republicans face a Friday deadline to approve a stopgap budget bill to avert a government shutdown, delaying until later this month key decisions on healthcare priorities like renewing children’s insurance and...more

OIG Rescinds Advisory Opinion

by Holland & Knight LLP on

The Department of Health and Human Services Office of Inspector General (the OIG), on November 28, 2017, issued a Rescission Letter terminating Advisory Opinion Number 06-04 (Advisory Opinion 06-04). In Advisory Opinion...more

CMS Rolls Back Mandatory Bundled Payment Programs

The Trump administration is putting the brakes on a payment model that gained steam across the health care industry under the Obama administration. The Centers for Medicare & Medicaid Services announced yesterday it is...more

CMS Provides Advice On Electronic Laboratory Alerts

by Fox Rothschild LLP on

CMS recently issued an Advisory Opinion suggesting that physicians who refer diagnostic tests reimbursable under Medicare to a laboratory may, under certain circumstances, receive electronic pop-up notifications in the...more

MACRA Quality Payment Program Final Rule: Implications for 2018 and Beyond

On November 2, 2017, CMS published its final rule (the “Final Rule”) on the 2018 Quality Payment Program (“QPP”), authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). This final rule adopted many...more

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