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Showing 58 posts in Centers for Medicare & Medicaid Services (“CMS”).

FINALLY SOME RELIEF TO PROVIDERS—CMS ORDERED TO NO LONGER APPLY A COMMON RULE OF THUMB WHEN AUDITING

May 30, 2014
Posted In Audit, Centers for Medicare & Medicaid Services (“CMS”), Jimmo v. Sebelius, Maintenance Standard

Health care providers are always at risk of a payor audit, and contracted auditors seem to be more aggressive now than ever. While MIC, MAC, and ZPIC audits as well as pre-payment reviews of late have become more efficient with the use of rules of thumb to flag specific codes commonly misapplied, the U.S. District Court of Vermont’s ruling in Jimmo v. Sebelius puts the brakes on such fishing expeditions.   In holding that, in the case of skilled nursing services, there is no “improvement standard” and claims should be reviewed on a case by case basis, the court has limited CMS in its ability to apply arbitrary standards in denying reimbursement for covered services. More >

Time to “Face” The Risks

May 22, 2014
Posted In Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Hospice, Overpayments

In 2011, the U.S. Centers for Medicare and Medicaid Services (“CMS”), as part of the reform instituted by the Affordable Care Act, required that home health agencies and hospice patients receive a face-to-face visit (at specified time periods) by a physician or nurse practitioner to ensure that they continue to meet Medicare and Medicaid eligibility criteria. More >

New Enrollment and Re-Validation Requirements for Providers/Suppliers for Participation in Medicare and Medicaid: Watch Your Mail! Part I

April 3, 2014
Posted In Abuse and Waste, Affordable Care Act, Centers for Medicare & Medicaid Services (“CMS”), Compliance Officer, Compliance Programs, Enrollment, Health Care Law, Medicare, Re-validation

Even though the Centers for Medicare and Medicaid Services (“CMS”) published final regulations to implement provisions to the Affordable Care Act (“ACA”) on February 2, 2011, it is likely that many Kentucky health care providers, including physicians, are not aware of the importance of the new requirements for revalidation of Medicare and Medicaid enrollment or the new and more burdensome requirements for initial enrollment. The requirements are aimed at strengthening provider and supplier screening procedures to reduce fraud, waste, and abuse in federal health care programs. Because CMS contractors and KY Medicaid have been slow to comply with these new requirements, it is likely that many providers have not noticed the enrollment/screening changes unless they have been asked to revalidate or have applied for new or additional provider/supplier numbers. More >

Changes Halted on Medicare Prescription Drug Program

March 27, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Healthcare Regulation, Medicare, Medicare Part D

After receiving bipartisan opposition and heavy concern from patient groups and insurers, the Centers for Medicare and Medicaid Services (“CMS”) has declared that it will not be moving forward with draft regulations released in January which proposed several changes to the Medicare Part D program. More >

New Rule Brings Sweeping Changes to Physician Privacy

February 11, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Health Reform, Medicare, Payors, Physician Payments

On January 17, the U.S. Department of Health and Human Services (HHS) announced that the Centers for Medicare & Medicaid Services (CMS) would begin granting Freedom of Information Act (FOIA) requests for Medicare reimbursement to individual physicians on a “case-by-case basis.”  The new policy, effective March 18, 2014, is a departure from CMS’ long-standing practice of withholding information on physician reimbursement under the Medicare program. More >

The Sun is Not Setting on the EHR Safe Harbor

January 7, 2014
Posted In Anti-Kickback Statute, Centers for Medicare & Medicaid Services (“CMS”), Compliance Officer, EHR Systems, EHR vendor, Electronic Health Records (“EHR"), Electronic Protected Health Information (ePHI), Stark Laws

The Centers for Medicare & Medicaid Services (“CMS”) and the U.S. Department of Health & Human Services Office of the Inspector General (“OIG”) recently announced that the regulation allowing certain health care entities to donate electronic health records (with the entity subsiding up to 85% of the donor’s costs) to physicians has been extended to December 31, 2021. The regulation, which provided a safe harbor from the Stark Law and Anti-kickback statute, was set to expire on December 31, 2013. More >

New Guidance for Skilled Nursing Facilities’ DNR and CPR Policies

December 19, 2013
Posted In Centers for Medicare & Medicaid Services (“CMS”), CPR, Health Care Law, Skilled Nursing Facilities (“SNFs”)

Last year, a Registered Nurse working in an independent living facility refused to initiate CPR on an elderly resident who was experiencing respiratory distress, even as a 911 dispatcher begged her to do so. The 911 call was released, and the story made national headlines. Many condemned the nurse for her actions, but the nurse was simply following the facility’s no-CPR policy. More >

Does the Shutdown “Shut Down” Health Care?

October 15, 2013
Posted In Affordable Care Act, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services (“CMS”), Food and Drug Administratio, National Institutes of Health, Office of Inspector General of the United States Department of Health and Human Services (OIG)

The ongoing partial federal government shutdown that began on October 1, 2013, was initiated in an effort to defund the Affordable Care Act (“ACA”). Now, it seems that the shutdown is affecting everything but the ACA. More >

Clarifying the “Two-Midnight Rule” and Part A Payments, cont.

September 12, 2013
Posted In "Two Midnights Rule", Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Hospitals, Inpatient Care, Part A, Part B

Earlier this week, I discussed CMS’ final rule on the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. The final rule provides guidance to physicians on how to designate a patient as inpatient or outpatient and the impact of the designation on Medicare Part A or Part B coverage. This blog will discuss the two midnight rule. More >

Clarifying the “Two-Midnight Rule” and Part A Payments

September 10, 2013
Posted In "Two Midnights Rule", Centers for Medicare & Medicaid Services (“CMS”), Hospitals, Inpatient Care, Part A, Part B

In August, the Centers for Medicare and Medicaid Services (“CMS”) announced a final rule regarding the prospective payment for acute care and long-term care hospital inpatient services for fiscal year 2014. This rule becomes effective on October 1, 2013. More >

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