News & Analysis as of

Outpatient Prospective Payment System (OPPS)

K&L Gates Triage: 340B Update: State Medicaid 340B Billing Requirements

by K&L Gates LLP on

In the midst of the ongoing federal conversation surrounding the 340B Drug Pricing Program, individual states are implementing a number of regulatory efforts related to the 340B Program at an increasingly fast pace. These...more

CMS Issues Updated Medicare Payment and Billing Policies for 340B Hospitals

by Baker Ober Health Law on

On April 2, 2018, CMS issued updated guidance related to the dramatic Medicare payment reductions that went into effect this year for certain 340B hospitals. The guidance explains the planned application of the payment cuts...more

MedPAC Considers Recommendation to Cut Payment to Off-Campus Emergency Departments, Shift Payments to Rural Facilities

by King & Spalding on

The Medicare Payment Advisory Commission (MedPAC) is considering asking Congress to cut Medicare payments for off-campus emergency departments located in urban areas and increase payments to stand-alone outpatient and...more

340B Update: Trump Administration’s 2019 Budget and White House Council of Economic Advisors Signal Further Changes to 340B...

by K&L Gates LLP on

On February 12, 2018, the Trump Administration released its fiscal year (“FY”) 2019 budget request to Congress outlining several proposals related to the 340B Drug Pricing Program (the “340B Program”) including a modification...more

Medicare 340B Drug Payment Policy Survives Legal Challenge; Hospitals Say, It's Not Over

by Baker Ober Health Law on

A federal court has handed CMS an initial legal victory enabling drastic cuts in Medicare Part B payment to take effect for separately payable drugs and biologicals purchased by hospitals under the 340B Drug Discount Program...more

340B Update: Hospitals Appeal Ruling on OPPS Reimbursement Cut; House Committee Issues Report Recommending Changes to 340B Program

by K&L Gates LLP on

The beginning of 2018 has brought significant developments relating to the federal 340B Drug Pricing Program (“340B Program”). On January 1, reimbursement under the Medicare Part B hospital Outpatient Prospective Payment...more

Off-campus provider-based hospital outpatient departments: Challenges and options in 2018

by Bricker & Eckler LLP on

2017 was another challenging year for hospitals grappling with site-neutral payment changes for off-campus provider-based hospital outpatient departments (OCPBDs). ...more

340B Drug Pricing Program Litigation Update

In November of last year, we wrote about a preliminary injunction being sought by hospital advocacy groups attempting to stop implementation of the Trump administration’s cuts to the 340B Drug Pricing Program (“340B...more

District Court Grants Government’s Motion to Dismiss Legal Challenge to Medicare Rate Cut for 340B Discounted Drugs

by King & Spalding on

On December 29, 2017, the United States District Court for the District of Columbia granted the government’s motion to dismiss a pre-implementation challenge to CMS’s policy to cut the Medicare reimbursement rate for...more

Capitol Hill Healthcare Update

by BakerHostetler on

Lawmakers return to Capitol Hill this week ahead of more self-imposed deadlines to resolve a series of thorny healthcare policies, including funding for the Department of Health and Human Services (HHS) and the rest of the...more

340B Update for Hospitals: CMS Publishes FAQs Clarifying Use of Modifiers in Connection with 340B Program Reimbursement Cut on...

by K&L Gates LLP on

On December 13, 2017, the Centers for Medicare & Medicaid Services (“CMS”) published subregulatory guidance to answer questions about billing for drugs acquired through the 340B Drug Pricing Program (“340B Program”)...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

ML Strategies December 2017 Legislative Preview

The culmination of the year’s legislative activity all comes down to the month of December – so buckle up. Congress will need to pass a government spending bill by December 8th, and this bill is expected to carry a...more

Proposed Legislation Aimed to Block 340B Drug Discount Program Cuts

by King & Spalding on

On November 15, 2017, a bipartisan bill was introduced in the U.S. House of Representatives aimed at preventing CMS from reducing reimbursement by nearly 30 percent for Medicare Part B drugs purchased by certain hospitals...more

The 340B Drug Pricing Program: New CMS Final Rule Draws a Motion for Preliminary Injunction from Hospital Groups

On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the final rule, “Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting...more

CMS Releases Final 2018 Medicare Payment Regulations

by Baker Donelson on

On November 1 and 2, the Centers for Medicare and Medicaid Services (CMS) released the final 2018 Medicare Payment Regulations for the Physician Fee Schedule, Hospital Outpatient Prospective Payment System and Ambulatory...more

340B Hospitals File Suit in Wake of Hospital Outpatient Cuts

by Foley Hoag LLP on

On November 13, 2017, a group of hospital trade associations (the American Hospital Association, the Association of American Medical Colleges, and America’s Essential Hospitals), along with two health system providers, filed...more

K&L Gates Triage: 340B Update: CMS Finalizes 340B Program Reimbursement Cut on Part B Drugs

by K&L Gates LLP on

In this episode, Richard Church and Ryan Severson discuss the recent decision by the Centers for Medicare and Medicaid Services (CMS) to substantially decrease reimbursement under the Outpatient Prospective Payment System...more

CMS Releases Final OPPS Rule: Removes Total Knee Replacements from IOP List; Adds Three New ASC Eligible Procedures

On November 6, 2017, CMS published its final rule for the 2018 Outpatient Prospective Payment System (OPPS). The changes will go into effect January 1, 2018. Among other changes, the rule will allow Medicare payment for...more

Top Takeaways for Medicare Physician and Hospital Payments in 2018

by Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2017, released the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Final Rule for...more

CMS Finalizes Reimbursement Cuts for 340B Hospitals

by Foley & Lardner LLP on

In a striking blow to 340B hospitals, the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) released a final Medicare Outpatient Prospective Payment System (OPPS) rule adopting its...more

CMS Finalizes Changes in CY 2018 OPPS and PFS Final Rules

by K&L Gates LLP on

On November 1, 2017, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule with comment period revising the Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and the Medicare Ambulatory...more

CMS Issues Final OPPS Rule, Slashing Reimbursement for 340B Drugs

by King & Spalding on

On November 1, 2017, CMS issued the 2018 Hospital Outpatient Prospective Payment System (OPPS) final rule in which it finalized steep cuts to reimbursement for drugs purchased through the 340B Drug Pricing Program, among...more

340B Update: CMS Finalizes 340B Program Reimbursement Cut on Part B Drugs

by K&L Gates LLP on

On November 1, 2017, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule updating the Medicare hospital Outpatient Prospective Payment System (“OPPS”) for the calendar year 2018. As part of this update,...more

CMS Releases 2018 OPPS/ASC Payment Systems Final Rule

The Centers for Medicare and Medicaid Services (CMS) issued the 2018 Medicare: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Final Rule with comment...more

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