News & Analysis as of

Provider Payments

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

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

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

‘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

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

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

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

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

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

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

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

CMS Finalizes Medicare OPPS, ASC Rates and Policies for CY 2018

by Reed Smith on

CMS has published a final rule updating Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2018. In addition to rate...more

Final Home Health Rule Drops Controversial Proposed Payment Model

by Bass, Berry & Sims PLC on

Last week, home health agencies welcomed the Centers for Medicare & Medicaid Services' (CMS) decision to drop a controversial proposed payment model and leave largely unchanged the current payment system. Responding to...more

New Audits and Penalties on Medicaid Plans and Providers Related to Encounter Data in Value-Based Payment Models

by Epstein Becker & Green on

For value-based payments, encounter data[1] provides valuable information in much the same way that claims data does for fee-for-service arrangements. With the growing prevalence of value-based payments, especially in the...more

Two Significant Medicaid Releases

by Dentons on

The Centers for Medicare and Medicaid Services (CMS) has released two important Medicaid guidance documents. The first, released on November 2, 2017, is a Center for Medicaid and CHIP Services (CMCS) informational bulletin...more

CMS Requests Industry Feedback on "New Direction" for the Innovation Center

by Baker Ober Health Law on

CMS is seeking comments through a Request for Information (RFI) on a "new direction" for the CMS Innovation Center. The RFI includes focus areas identified by CMS, but the RFI welcomes all stakeholder input on "additional...more

OIG Finds Acute Care Hospitals Improperly Billed for Outpatient Services Provided to Inpatients of Other Hospitals

by Baker Ober Health Law on

Acute care hospitals that provide Medicare outpatient services to inpatients of other hospitals should be billing and collecting payment from the other inpatient hospitals and not from Medicare....more

SuperVision - Labor & Employment Law Insights - September 2017

...This issue of SuperVision is dedicated to questions our friends and clients may have regarding insurance and benefit topics. While not a common part of the Labor & Employment field, Spilman prides itself on having...more

CMS Proposes New Payment Model and Other Changes for Home Health Agencies

by Bass, Berry & Sims PLC on

Among the various payment updates proposed by the Centers for Medicare and Medicaid Services (CMS) this summer, the proposed payment update for the home health agency prospective payment system (HHA-PPS), published in the...more

CMS Proposes to Cancel EPM and CR Bundled Payment Programs and to Reduce Mandatory Participation in CJR Model

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule (Proposed Rule) to scale back its mandatory bundled payment programs. Under the Proposed Rule, CMS would cancel the episode payment...more

Health Alert (Australia) 4 September 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 30 August 2017 - Australian Competition and Consumer Commission v Medibank Private Limited [2017] FCA 1006 - In this proceeding,...more

Medicare Payments for Telehealth Increased 28% in 2016: What You Should Know

by Foley & Lardner LLP on

Telehealth providers can celebrate another successful year of growth, as CMS reported a 28% increase over total 2016 payments for telehealth services under the Medicare program. Providers continue to successfully integrate...more

Mandatory Cardiac Episode Payment Program: CMS Proposes Cancellation

by Foley & Lardner LLP on

On August 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (Proposed Rule) that, if finalized, would (1) reduce the number of Metropolitan Statistical Areas (MSAs) in which there is...more

CMS Aims to Nix Obama-Era Payment Models

In a proposed rule published Tuesday, August 15, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its intention to roll back a handful of payment models introduced under the Obama Administration. If...more

CMS Merely Soliciting Comments on Including Total Joints as ASC Procedures

by Tucker Arensberg, P.C. on

CMS released the proposed update for the Hospital Outpatient Perspective Payment System and the Ambulatory Surgery Center System on July 13, 2017, and the release has generated some unexpected controversy regarding the...more

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