News & Analysis as of

Required Documentation Centers for Medicare & Medicaid Services (CMS)

Perkins Coie

New CMS Rule Requires Extrapolation of Medicare Advantage RADV Audit Findings

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The Centers for Medicare and Medicaid Services (CMS) published its final rule regarding the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program in early February 2023. Among other matters, the final rule...more

Jackson Lewis P.C.

Long-Term Care Facilities Must Educate, Offer, And Report on COVID-19 Vaccinations For Residents And Staff, According To CMS...

Jackson Lewis P.C. on

On May 11, 2021, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health & Human Services published an interim final rule/guidance to establish COVID-19 vaccination requirements for Long-Term Care...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 43. News Briefs: December 2020

Report on Medicare Compliance 29, no. 43 (December 7, 2020) - In a new provider compliance audit, the HHS Office of Inspector General (OIG) said The Palace at Home, a for-profit home health care agency (HHA) in Miami,...more

Bricker Graydon LLP

Reminder to providers: CMS modified supporting documentation requirements for cost-reporting periods beginning on or after October...

Bricker Graydon LLP on

On August 17, 2018, the Centers for Medicare and Medicaid Services (CMS) issued the FY 2019 Medicare IPPS final rule. Part of the rule modified the supporting documentation required under 42 CFR 413.20 to be submitted with...more

Baker Donelson

CMS Seeks Additional Ideas for Reducing Administrative Burdens in Health Care

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The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) focused once again on reducing the administrative burden for physicians by reviewing and revising regulations. The RFI, published...more

Sheppard Mullin Richter & Hampton LLP

Take-Aways from CMS’ Recent Listening Session Regarding E/M Services: Documentation Guidelines and Burden Reduction

On March 21, 2018, a representative from the Hospital and Ambulatory Policy Group at the CMS, held a listening session regarding proposed updates to documentation guidelines for Evaluation and Management (“E/M”) Services. The...more

Robinson+Cole Health Law Diagnosis

CMS Announces Change to Student Documentation Requirement Intended to Reduce Burden on Teaching Physicians

On February 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 3971 (Change Request 10412), which revises a section of the Medicare Claims Processing Manual (Manual), that provides guidance...more

Stinson LLP

Recent Case Highlights Risks of Paying Physicians for Routine Duties - Signed writing required, informal documentation may not be...

Stinson LLP on

Payments to physicians, even for routine, necessary duties, may cause referrals to the entity making the payments to be "prohibited referrals" under the Stark Law. This means the hospital or other entity should not have...more

Burr & Forman

Revocation of Enrollment in the Medicare Program- A Powerful Weapon in Medicare’s Arsenal

Burr & Forman on

In 2014, CMS issued a final rule related to 42 CFR 424.535, which gave CMS expanded authority to impose penalties on providers. Although the rule is several years old, the first version published in 2006, the rule has been...more

Foley & Lardner LLP

OIG and CMS Issue Rule: Finalizing Fraud and Abuse Waivers for MSSP ACOs

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The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services just issued a final rule setting forth waivers of specified fraud and abuse laws...more

Manatt, Phelps & Phillips, LLP

Health Update - September 2015

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

King & Spalding

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

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The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

Davis Wright Tremaine LLP

Emerging EHR Risks: When Documentation May Not Be Enough (or Too Much)

Today’s Electronic Health Record (EHR) technologies feature many tools that help providers practice more efficiently and allow them to spend more time caring for patients. However, the federal government recently has posted...more

Baker Donelson

CMS Provides Clarification Regarding HHA Face-to-Face Documentation

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In January 2014, CMS released a Special Edition Article of MLN Matters to clarify the documentation requirements for Home Health Prospective Payment System (HH PPS) Face-to-Face Encounters. CMS found that insufficient...more

Baker Donelson

CMS Issues FAQs Regarding Self-Referral Disclosure Protocol

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CMS has released its responses to eight frequently asked questions [PDF] regarding its Self-Referral Disclosure Protocol (SRDP). The questions fall into three categories, listed below, and respond to issues that are often...more

Perkins Coie

CMS Adopts New “2 Midnights” Presumption For Inpatient Hospital Admissions

Perkins Coie on

On August 2, 2013, the Centers for Medicare and Medicaid Services (CMS) issued an advance copy of its final rulemaking that adopts a new approach to evaluating the medical necessity of inpatient hospital admissions. ...more

Baker Donelson

RAC Relief (Sort Of)

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CMS announced that it would reduce the number of additional documentation requests (ADRs) available to its Recovery Audit Contractors (RACs). ...more

King & Spalding

CMS Issues Revised Provider and Supplier ADR Limitations

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On April 3, 2013, CMS issued revised provider and supplier additional documentation request (ADR) limitations for the Recovery Audit Contractor (RAC) program. The revised provider ADR limitations are effective April 15,...more

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