News & Analysis as of

Overpayment Medical Reimbursement

Baker Donelson

CMS Proposes Significant Changes to the Medicare Shared Savings Program and 60-Day Rule

Baker Donelson on

Under the CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposes several modifications to the Medicare Shared Savings Program (MSSP) that would become effective in performance year 2025. CMS also proposed...more

Polsinelli

Provider Reimbursement Disputes Go Back to 1984 Following Supreme Court’s Regulatory Reset

Polsinelli on

One could forgive the healthcare industry for thinking someone drove Doc Brown’s DeLorean time machine through One First Street when it awoke on Friday, June 28, to a blast from the past....more

Nelson Mullins Riley & Scarborough LLP

Understanding the Medicare Overpayment Appeals Process

Every Medicare provider should understand the Medicare administrative appeals process. Providers are entitled to be reimbursed for their services and want to keep those reimbursements safe from audits. However, if Medicare...more

King & Spalding

Line Item Disallowances And Coding Denials

King & Spalding on

Health plans are using both new and old methods to deny healthcare providers’ claims, all of which are legally and factually unsupportable. These tactics have repeatedly been rejected by arbitrators in scores of arbitrations,...more

Sheppard Mullin Richter & Hampton LLP

CMS Rolls Out Provider Appeals Settlement Efforts

This year CMS is rolling out two new programs aimed, finally, at helping to settle certain types of pending provider reimbursement appeals. The programs are the Low Volume Appeals Initiative and Settlement Conference...more

Holland & Knight LLP

Ruling: Medical Providers Not Subject to Double Damages Under Medicare Secondary Payer Act

Holland & Knight LLP on

• In a matter of first impression, the U.S. District Court for the Middle District of Florida has ruled that a private right of action under the Medicare Secondary Payer Act (MSP Act), which provides for double damages in the...more

Franczek P.C.

Supreme Court to Hear Arguments Involving a Health Plan’s Right to Recover Plan Overpayments

Franczek P.C. on

While public attention is currently focused on the upcoming high profile Supreme Court decision in King v. Burwell (which involves subsidies for exchange-based coverage under the ACA), the Supreme Court recently decided to...more

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