Physician Compensation and Reimbursement
Polsinelli Podcast - Health Care Payment Changes: From Service to Value
News Briefs - Lawmakers Reintroduce Healthcare Workforce Resilience Act - Federal lawmakers are trying again to push through immigration reform that would allow officials to recapture unused visas and reprocess them for...more
Introduction On December 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (the “Act”). The Act provides for nearly $1.7 trillion in funding across a range of domestic initiatives, including certain...more
In the complex world of Medicare reimbursement, there are a multitude of payment formulae, mathematical adjustments, and reimbursement calculations that translate congressional policy into operational payments for hospital...more
The last two weeks of June saw several key developments affecting the 340B Drug Pricing Program—a federal government program created in 1992 that requires pharmaceutical manufacturers to provide outpatient drugs to eligible...more
Report on Medicare Compliance 30, no. 8 (March 1, 2021) - According to a CMS spokesperson, “CMS has not yet determined when Targeted Probe and Educate reviews will resume.” Meanwhile, “CMS continues to temporarily pause...more
Report on Medicare Compliance 30, no. 8 (March 1, 2021) - After the 2021 Medicare Physician Fee Schedule extended coverage of many telehealth services until the end of the public health emergency (PHE), including...more
As part of a broader Trump administration announcement made on August 25, 2020, the Centers for Medicare & Medicaid Services (CMS) issued sweeping oversight changes in the form of an Interim Final Rule with Comment Period...more
- Tucked into a massive Medicare payment rule is a proposal to fundamentally change how CMS sets hospital payment rates. - Recognizing that a hospital’s chargemaster rarely reflects true market costs, CMS seeks to use...more
Today, the Department of Health and Human Services (HHS) announced the delivery of the initial $30 billion tranche from the $100 billion provider relief fund established under the Coronavirus Aid, Relief, and Economic...more
Congress passed and the President signed the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. 116-136) (“CARES Act”) on March 27, 2020. We recently provided guidance on how the CARES Act impacts hospitals. ...more
The Centers for Medicare & Medicaid Services (CMS) has expanded its accelerated and advance payment program to provide immediate interest-free cash support to Medicare providers during the COVID-19 public health emergency. ...more
In response to the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced on Saturday March 28, 2020, that it is expanding its Medicare Accelerated and Advance Payment Program (AAPP) to...more
As reported in Seyfarth’s April 2, 2020 COVID-19 Update, the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. 116-136) (“CARES Act” or “Act”)...more
With the aim of enabling providers to focus attention and resources on fighting the COVID1-19 pandemic, CMS announced over the weekend that it intends to alleviate some of Medicare participating providers’ and suppliers’...more
On March 27, President Donald Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The CARES Act establishes the $100 billion Public Health and Social Services Emergency Fund (Fund) to...more
On the day following the enactment of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), the Centers for Medicare & Medicaid Services (CMS) made clear its intention to expand the groups of medical...more
Our Health Care Group highlights how the Centers for Medicare & Medicaid Services (CMS) has expanded the Accelerated and Advance Payment Program to respond to the coronavirus (COVID-19) pandemic....more
Information Collection Request. On November 27, 2019, 340B Health, a nonprofit membership organization comprised of hospitals and health systems that participate in the federal 340B drug pricing program (“340B Program”),...more
We continue to see activity in the hospital and health care system affiliation space. While few actually believe that the “Medicare for All” proposals will garner the support of a majority of the American people and are...more
The US Court of Appeals for the Third Circuit endorsed two controversial interpretations of the Stark Law’s “volume or value” standard, known as the correlation theory and the practice “loss” theory in U.S. ex rel. J. William...more
On September 17, 2019, the U.S. District Court for the District of Columbia ruled against the Centers for Medicare and Medicaid Services (“CMS”), vacating CMS’ 2018 Final OPPS Rule, which cut Medicare reimbursement rates for...more
In early August, the U.S. District Court for the Western District of Texas granted a hospital system’s motion to dismiss a False Claims Act case that illustrates the increasing intersections in FCA litigation between data...more
In a major win for providers that serve a disproportionate share of indigent patients, the Supreme Court today upheld the D.C. Circuit’s earlier decision invalidating CMS’s policy to treat beneficiaries enrolled in Part C...more
If one appellant has its way, the False Claims Act (FCA) would be gutted by way of its qui tam provisions struck down as unconstitutional by the United States Supreme Court. That is the position taken by Intermountain Health...more
On Friday, April 5, 2019, the Centers for Medicare and Medicaid Services (“CMS”) announced that it had finalized policies allowing Medicare Advantage plans (“MA Plans”) to include additional telehealth benefits in their basic...more