News & Analysis as of

Provider Payments

Foley & Lardner LLP

Six Key Investment and Strategic Themes from Payer-Provider Convergence Deals

by Foley & Lardner LLP on

At the 11th Annual Investment and M&A Opportunities in Healthcare conference in Nashville on June 6th, 2018, a panel session moderated by Chris Donovan, partner in Foley’s Health Care Practice Group, addressed the topic of...more

Baker Ober Health Law

CMS Refines Proposed Changes to SNF Reimbursement with Patient-Driven Payment Model

by Baker Ober Health Law on

On May 8, 2018, in its FY2019 SNF PPS Proposed Rule, CMS proposed a new case mix classification system that drives Medicare reimbursement for SNF inpatient services. The new system would go into effect on October 1, 2019. CMS...more

Robinson+Cole Health Law Diagnosis

Medicare Appeals Settlement Program Expanded

The Office of Medicare Hearings and Appeals (OMHA) has announced the expansion of their Settlement Conference Facilitation (SCF) program. ...more

Baker Ober Health Law

CMS Releases FY 2019 Proposed Payment Rules

by Baker Ober Health Law on

On April 24 and 27, 2018, CMS launched its annual gaggle of proposed regulations – each with the theme of "Patients over Paperwork" – with the stated goal of "advanc[ing] the agency's priority of creating a patient-driven...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

Snell & Wilmer

Telemedicine Reimbursement and Regulation: an Overview for Providers

by Snell & Wilmer on

The advent of telemedicine supplies a unique and convenient gateway for patients and providers to connect. The benefits of telemedicine range from increased access to care for patients, to increased efficiency and lower...more

Foley & Lardner LLP

California: Proposed Legislation Regulating Health Care Rates for Payors and Providers

by Foley & Lardner LLP on

An ambitious California proposal to regulate health care rates and curb long-term health care spending was unveiled last week in Assembly Bill 3087 (Proposed Legislation). The key concept in the Proposed Legislation is the...more

Baker Ober Health Law

Precision Medicine Advances: Medicare Coverage of Next Generation Sequencing Testing

by Baker Ober Health Law on

Medicare recently released a new national coverage determination (NCD) that addresses certain diagnostic laboratory tests using Next Generation Sequencing (NGS) for patients with advanced cancer. NGS technology has made it...more

Polsinelli

LVA Settlement Update

by Polsinelli on

The LVA settlement option is being offered to providers and suppliers with fewer than 500 Part A and B claims pending as of Nov. 3, combined, where no single claim appeal exceeds $9,000. These appeals will be settled at 62...more

K&L Gates LLP

K&L Gates Triage: Triage in 2018: Health Care Topics to Watch in the New Year

by K&L Gates LLP on

We expect 2018 to be another year of rapid change within the health care industry. In this episode, Mary Beth Johnston highlights some of the key topics that the health care practice group will monitor in the coming year,...more

Polsinelli

Breaking Down the Low Volume Appeals Settlement Option for Health Care Providers

by Polsinelli on

The Medicare Learning Network (MLN) recently held a second call, where it answered questions live about the Low Volume Appeals (LVA) Settlement Option and revealed more information that providers considering the option need...more

Baker Ober Health Law

The New Option in Town: Applying for the Low Volume Appeals Settlement

by Baker Ober Health Law on

In November 2017, the Department of Health and Human Services (HHS) announced new settlement options for providers and suppliers stuck in the backlog of the Medicare appeals process. One of the new options available is the...more

Baker Ober Health Law

OIG Offers Additional Guidance on Gainsharing Arrangement in Advisory Opinion 17-09

by Baker Ober Health Law on

A non-profit acute care hospital may share cost savings for certain spinal surgeries with neurosurgeons in a multi-specialty physician group following approval by the U.S. Department of Health & Human Services, Office of...more

Mintz Levin - Health Law & Policy Matters

A Guide to New Jersey’s New Limits on Pharmaceutical Industry Payments to Prescribers

The pharmaceutical industry is facing new limits on payments to prescribers in New Jersey. Earlier this month the state’s Division of Consumer Affairs finalized sweeping new rules prohibiting some types of payments and...more

Baker Ober Health Law

Court Upholds Procedural Validity of HHS's Outlier Reconciliation Instructions

by Baker Ober Health Law on

On December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit upheld the procedural validity of 2010 manual instructions setting out the criteria by which Medicare outlier payments might be...more

Hogan Lovells

Bundle Up: CMS Releases Request for Applications for New Version of Bundled Payments for Care Improvement Model

by Hogan Lovells on

This week, the Centers for Medicare & Medicaid Services (CMS) released details on the much-anticipated new version of the Bundled Payments for Care Improvement (BPCI) payment model, which will be known as BPCI Advanced. Like...more

Seyfarth Shaw LLP

CMS Publishes Final Rule to Cancel Medicare Episode Payment and Cardiac Rehab Incentive Payment Models, and to Cut Back Joint...

by Seyfarth Shaw LLP on

This is the first in a series of alerts from Seyfarth’s Health Law practice highlighting significant changes in health care regulations and policy as providers and other industry participants enter 2018. ...more

Sheppard Mullin Richter & Hampton LLP

‘Twas the Season to Contract? A Year-End Review of Network Negotiations and Billing Disputes

As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more

Bricker & Eckler LLP

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

Baker Ober Health Law

What's Next Now that Mandatory EPM and Cardiac Rehabilitation Payment Models Have Been Terminated?

by Baker Ober Health Law on

CMS released its Final Rule canceling the Episode Payment Model (EPM) and Cardiac Rehabilitation Incentive Payment Model (CR Incentive Payment Model). This was an expected result following August's proposed rule to cancel...more

Baker Ober Health Law

OIG November 2017 Work Plan Update

by Baker Ober Health Law on

The OIG added four items to its Work Plan with the November 2017 update, as listed on the chart below. Interestingly, three of the four new items relate to Medicaid. Hot topics include prescriptions for extreme amounts of...more

Akerman LLP - Health Law Rx

Medicare Providers Face December 1 Deadline to Request Review of Medicare Payment Adjustments

by Akerman LLP - Health Law Rx on

Providers have just a couple more days to challenge Medicare’s proposed 2018 value modifier payment adjustments. On September 18, 2017, Medicare released quality reports and measures used to calculate quality-based payment...more

Burr & Forman

Health Care E-Note - November 2017

by Burr & Forman on

Health care law and policy occupy a prime place in the current news cycle. Much of the attention revolves around the actions or inactions of Congress and the White House, particularly with regard to their impact on the future...more

Foley & Lardner LLP

New OIG Project Expands Telemedicine Audits to State Medicaid Programs

by Foley & Lardner LLP on

Following on the heels of its plans to review Medicare payments for telehealth services, the federal Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just announced a new project to review...more

Baker Ober Health Law

Home Health Payment Rule Published

by Baker Ober Health Law on

On November 1, 2017, CMS released the Final Rule for the 2018 home health prospective payment system rate update, including the CY 2019 case mix adjustment methodology refinements. CMS also made changes to the Value Based...more

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Updated: May 25, 2018:

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Information for EU and Swiss Residents

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Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

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Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

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Changes in Our Privacy Policy

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Updates to This Policy

We may update this cookie policy and our Privacy Policy from time-to-time, particularly as technology changes. You can always check this page for the latest version. We may also notify you of changes to our privacy policy by email.

Contacting JD Supra

If you have any questions about how we use cookies and other tracking technologies, please contact us at: privacy@jdsupra.com.

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