News & Analysis as of

Medicare Outpatient Services

King & Spalding

OIG Report Details Weaknesses in Enforcement of Two-Midnight Rule

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CMS estimates that between 2017 and 2021, Medicare Part A improperly paid $23.9 billion for inpatient hospital stays, with $7.8 billion attributable to short stays that did not qualify for Medicare Part A. On June 13, 2024,...more

Bass, Berry & Sims PLC

Behavioral Health: Momentum Continues in the CY 2024 Medicare Physician Fee Schedule

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On November 16, the Centers for Medicare & Medicaid Services (CMS) published its Medicare Physician Fee Schedule (PFS) final rule for calendar year 2024 (PFS Final Rule). According to the CMS press release, the PFS Final Rule...more

McDermott+

CMS Giveth and Taketh Away: The Long-Term Impact of the 340B Remedy Policy

McDermott+ on

In the buffet of regs (and eggs) released a couple of weeks ago, the fried egg served up by the Centers for Medicare & Medicaid Services (CMS) was the 340B Remedy Final Reg. Unlike the other final regs that will affect...more

Arnall Golden Gregory LLP

CMS Expands Access to Behavioral Health Outpatient Services

The Centers for Medicare & Medicaid Services (“CMS”) announced it is expanding access to behavioral health services for Medicare beneficiaries through intensive outpatient services coverage. In general, Medicare will cover...more

Quarles & Brady LLP

HRSA Notice Provides Clarity on 340B Child Site Registration Requirements

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After months of relative uncertainty, the Health Resources and Services Administration (HRSA) published a Notice confirming the end to a COVID-19 pandemic-era flexibility that allowed unregistered child sites to utilize 340B...more

McDermott+

Previewing the Final Hospital Outpatient Medicare Payment Reg

McDermott+ on

Sharpen your pencils and locate your reading glasses: the final Medicare payment regulations for calendar year (CY) 2024 will be released within the next week. In the last Regs & Eggs blog post, I discussed a major issue...more

Venable LLP

CMS Proposes Behavioral Health Program Changes

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On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a proposal to significantly expand behavioral health coverage provided under Medicare. The proposal, presented as a part of the calendar year 2024...more

Holland & Knight LLP

CMS Releases CY 2024 OPPS and ASC Proposed Rule

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS-1786-P),...more

McDermott+

Breaking Down the CY 2024 Hospital Outpatient Proposed Reg

McDermott+ on

As most of you already know, the Centers for Medicare & Medicaid Services (CMS) recently released two Medicare payment regulations: the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed reg and the CY 2024...more

McDermott+

The CY 2024 Physician Fee Schedule Proposed Reg: The Good, the Bad and the Ugly

McDermott+ on

Last week, the Centers for Medicare & Medicaid Services (CMS) released the two major regulations we all were waiting for: the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed reg and the CY 2024 Outpatient...more

K&L Gates LLP

Health Care Triage: Rural Emergency Hospitals — Transformative Change or Limited Impact?

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In this episode of Triage, Andrew Ruskin, Darlene Davis, and Gabriel Scott discuss key provisions associated with conversion to CMS’s new rural emergency hospital provider type. They review the purpose of the new provider...more

Greenbaum, Rowe, Smith & Davis LLP

Many Hospitals Remain in Noncompliance with Price Transparency Rule: House Committee Urges More Oversight

What You Need to Know- •The Hospital Price Transparency Rule requires hospitals to annually make public a comprehensive list of the hospital’s standard charges for provided items and services, including a display of charges...more

McDermott Will & Emery

Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and...

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Rural emergency hospitals (REHs) are a new provider type that will allow Medicare to pay for emergency department and other outpatient hospital services in rural areas beginning on January 1, 2023, without requiring the...more

McDermott Will & Emery

[Webinar] Critical Access Hospital and Rural Emergency Hospitals: Proposed Rules and Opportunity for Input - August 23rd, 12:30 pm...

McDermott Will & Emery on

Beginning in 2023, Medicare will recognize a new provider type: the Rural Emergency Hospital (REH). The establishment of REHs is intended to preserve access to emergency departments and other outpatient services in rural...more

McDermott Will & Emery

CMS Proposes Key Details for Payment Methodology, Quality Measures and Enrollment Policies for Rural Emergency Hospitals

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Rural emergency hospitals (REHs) are a new Medicare provider type that will allow Medicare to pay for emergency department and other outpatient hospital services in rural areas beginning on January 1, 2023, without requiring...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 32. News Briefs: September 2021

Report on Medicare Compliance 30, no. 32 (September 13, 2021) - Saint Francis Medical Center in Missouri agreed to pay $1.625 million in a civil settlement of allegations it violated the Controlled Substances Act, the...more

Sheppard Mullin Richter & Hampton LLP

Biden’s American Rescue Plan Follows Trend Toward Outpatient Setting, Increase in ASC Investment

The Biden Administration’s American Rescue Plan Act of 2021 (H.R. 1319) (the “Act”) could present an opportunity for the growth of utilization of ambulatory surgery centers (“ASCs”), continuing the trend of migration of...more

Health Care Compliance Association (HCCA)

CMS offers correct billing tips for nonphysician outpatient services provided before or during inpatient stays

Compliance Today (March 2021) - The Centers for Medicare & Medicaid Services (CMS) has provided the following compliance notice: “In a recent report, the Office of Inspector General (OIG) determined that Medicare made...more

Alston & Bird

Alston & Bird Health Care Week in Review - December 2020 #1

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in healthcare regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and...more

Health Care Compliance Association (HCCA)

CMS Hikes Payment for COVID-19 Inpatients Treated With New Drugs, Links it to 20% Bonus

Report on Medicare Compliance 29, no. 39 (November 2, 2020) - CMS said Oct. 28 that Medicare will pay hospitals extra when they treat inpatients with drugs or biologicals approved by the Food and Drug Administration (FDA)...more

K&L Gates LLP

2021 Physician Fee Schedule Proposed Rule

K&L Gates LLP on

On 3 August 2020, the Centers for Medicare & Medicaid Services (CMS) released its Physician Fee Schedule (PFS) proposed rule (Proposed Rule) for Calendar Year (CY) 2021.1 The agency will accept comments on the Proposed Rule...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

McDermott Will & Emery

CMS Issues COVID-19 Infection Control Guidance for Certain Outpatient Settings

On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) released a Quality, Safety & Oversight Group (QSO) memorandum (QSO-20-22-ASC, CORF, CMHC, OPT, RHC/FQHCs) addressing standards for infection control and...more

Womble Bond Dickinson

2021 Changes for Evaluation and Management Services

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E/M office visit historical background - For years, providers have voiced their concerns about the amount of data entry required for Evaluation and Management (E/M) visits. Many state they spend twice as much time...more

Chambliss, Bahner & Stophel, P.C.

Medicare Now Covers Outpatient Treatment for Opioid Addiction

Recognizing the huge problems caused by opioid addiction in the United States, Medicare is adding a new outpatient opioid treatment benefit, paying for methadone and related treatment in certain facilities. Under a new...more

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