News & Analysis as of

Medicare HCPCS

Harris Beach PLLC

HHS OIG Work Plan – December Update – Audits for Medicare Emergency Codes

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In its December 18, 2023, Enforcement listserv notice, HHS’s Office of Inspector General (“OIG”) published its Work Plan Updates for December. Although six updates were published, this article will only highlight the...more

Foley & Lardner LLP

Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM): A Deep Dive into Proposed Medicare Changes

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On July 13, the Centers for Medicare & Medicaid Services (CMS) released its annual Proposed Rule updating the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2024, which includes various proposed changes related...more

Hogan Lovells

When being a little bit square is a good thing: CMS AppliedVR decision shows how innovative technology can secure a payment...

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While the Medicare statute provides access to healthcare services for our nation’s elderly and disabled populations, it also can serve to foreclose access for those populations when an item or service does not fall within one...more

Foley & Lardner LLP

Medicare Remote Therapeutic Monitoring: Top FAQs for 2023

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On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) finalized new policies related to remote therapeutic monitoring (RTM) services reimbursed under the Medicare program. The changes, part of the...more

Bass, Berry & Sims PLC

CY 2023 Medicare Physician Fee Schedule: Big Strides for Behavioral Health

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On November 2, 2022, the Centers for Medicare & Medicaid Services (CMS) filed its Medicare Physician Fee Schedule (PFS) final rule (Final Rule) for calendar year (CY) 2023. CMS finalized several noteworthy updates specific to...more

King & Spalding

OIG Recommends CMS Use OIG Hospital Compliance Audits to Enhance its Medicare Oversight

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On October 26, 2022, OIG published a report summarizing the results of 12 OIG hospital compliance audits covering Medicare claims paid from 2016 through 2018. OIG recommends, among other things, that CMS follow up on...more

King & Spalding

CMS Issues CY 2023 Physician Fee Schedule Proposed Rule

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On July 7, 2022, CMS released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule (the Proposed Rule). The Proposed Rule includes proposed policy changes for Medicare payments under the Physician Fee...more

Foley & Lardner LLP

Remote Therapeutic Monitoring: What You Need to Know About CMS’ Proposed Changes

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On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed five new changes to Remote Therapeutic Monitoring (RTM) services under the Medicare program. The changes, part of the proposed 2023 Medicare...more

Manatt, Phelps & Phillips, LLP

Audio Telehealth Services Post-Pandemic—An Update on Emerging Policy Trends

As highlighted in our September 2020 article, “Frequently Asked Questions: Telephonic Services as a Form of Telehealth,” in response to the COVID-19 pandemic, federal and state policy makers have significantly increased...more

King & Spalding

CMS Proposes New DMEPOS Coverage Policies and Payment Rates, and Seeks to Codify HCPCS Application, Benefit Category and Payment...

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On November 4, 2020, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (the Proposed Rule) outlining proposals for the coverage and payment for durable medical equipment, prosthetics, orthotics, and...more

King & Spalding

CMS Releases Calendar Year 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule

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On December 2, 2020, CMS issued the calendar year (CY) 2021 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. Through these policy changes, CMS seeks to...more

Foley & Lardner LLP

Top Five New Telehealth Policies in Medicare 2021 in Physician Fee Schedule

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The Centers for Medicare and Medicaid Services (CMS) just released its 2021 Final Rule (Physician Fee Schedule), with telehealth policy changes and a list of new services covered under Medicare. Actions taken by CMS during...more

Ward and Smith, P.A.

Time for a Checkup: Recent Federal Efforts Regarding Telehealth - Part I

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The public health emergency (PHE) for COVID-19 has brought about many changes to the way healthcare is practiced, delivered, and reimbursed. This article will discuss some of the major recent changes to telehealth on the...more

King & Spalding

CMS Releases Proposed 2021 Physician Fee Schedule

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On August 3, 2020, CMS issued a proposed rule which updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2021 (the...more

Bricker Graydon LLP

Medicare to require prior authorization for certain outpatient department services starting July 1, 2020

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In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior authorization process and...more

Health Care Compliance Association (HCCA)

CMS reveals new HCPCS code for coronavirus lab tests

Compliance Today (May 2020) - The Centers for Medicare & Medicaid Services (CMS) announced on March 6, 2020, in a special edition of MLN Connects[1] that the agency has taken “additional actions to ensure America’s...more

Brownstein Hyatt Farber Schreck

Health Plan Coverage of Coronavirus Testing and Treatment

With the news about the spread of the 2019 novel coronavirus (“COVID-19”) in the U.S. and the world rapidly evolving, group health plan sponsors need to address how the plan will provide virus-related benefits. ...more

Holland & Knight LLP

CMS Issues New Medicare Reimbursement Guidance for Diagnosis and Treatment of Coronavirus

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The Centers for Medicare and Medicaid Services (CMS) has issued new guidance for frequently asked questions related to Medicare reimbursement for items and services provided in connection with the diagnosis and treatment of...more

Bricker Graydon LLP

COVID-19 Update: Reimbursement issues – Who is picking up the tab for coronavirus testing?

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Insurance coverage - In a statement on March 6, 2020, the Board of Directors for America’s Health Insurance Plans (AHIP) announced that insurers are voluntarily covering the diagnostic testing of COVID-19 (coronavirus)...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 4. News Briefs: February 2020

Report on Medicare Compliance 29, no. 4 (February 3, 2020) - ? Central Coast Inpatient Consultants Inc. in California has agreed to pay $750,000 in a civil monetary penalty settlement with the HHS Office of Inspector...more

Baker Donelson

CMS Adopts Important "Site-Neutral" Changes to Payment Rules

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CMS took another step in its campaign to impose "site neutrality" on hospital outpatient payments with its recently published final Medicare hospital Outpatient Prospective Payment System (OPPS) rule for CY 2019. The final...more

Cozen O'Connor

Medicare’s New Virtual Check-In Code: 7 Things You Need To Know

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On November 1, 2018, CMS issued a 2,379 page final rule titled “Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2019.” While there are...more

Foley & Lardner LLP

Understanding Medicare’s New Remote Evaluation of Pre-Recorded Patient Information (Asynchronous Telemedicine)

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Starting January 1, 2019, the Medicare program will cover certain medical services delivered via asynchronous telemedicine technologies. The Centers for Medicare and Medicaid Services (CMS) just published the final rule for...more

Foley & Lardner LLP

Top 10 FAQs on Medicare’s Virtual Check-In Codes: The New Brief Communication Technology-Based Service

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Telemedicine providers rejoice: Medicare will cover new virtual care services starting January 1, 2019. The Centers for Medicare and Medicaid Services (CMS) just published the final rule for the 2019 Physician Fee Schedule,...more

Foley & Lardner LLP

Medicare Proposes (and Rejects) New Telehealth Services for 2019

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The telemedicine industry was pleased to learn CMS recently proposed adding new services to its list of Medicare-covered telehealth services. But what may be more interesting are the services CMS declined to add, and why....more

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