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Showing 17 posts tagged Centers for Medicare & Medicaid Services.

OIG and CMS Audits Present New Round of Compliance Concerns for Healthcare Providers

Since the beginning of the Public Health Emergency, Centers for Medicare and Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) data reflect over 44 million COVID-19 cases, 3 million COVID-19 related hospitalizations, and 720,000 COVID-19 deaths. COVID-19 has placed enormous stress on our healthcare system. Federal and state responses to COVID-19 have woven a complex and complicated safety net by easing regulatory requirements through waivers and funneling billions of dollars to providers among many other actions.  Just as the pandemic may finally be easing, federal focus on use of COVID-19 resources promises to increase healthcare providers’ stress.  More >

SCOTUS Blocks OSHA ETS; Healthcare Mandate Moves Forward

Thursday afternoon, the United States Supreme Court ruled to block the Emergency Temporary Standard (ETS) issued by the U.S. Occupational Safety and Health Administration (OSHA) that would require private employers of 100 or more workers to mandate employee vaccination against COVID-19, or weekly testing for the virus. The Court upheld, however, a similar rule for healthcare employers contracted with the Centers for Medicare and Medicaid Services (“CMS”) as further outlined below. More >

Policy Reversal Means Return of Per Day Fines for Nursing Homes

On July 19, 2021, the Center for Medicare and Medicaid Services (“CMS”) rescinded a guidance issued in 2017 that significantly limited the discretion of CMS Locations to impose substantial fines for noncompliance. (For reference, the 2017 Guidance can be found here. The accompanying CMP Analytic Tool can be found here.)  More >

Pandemic Pivot to Telemedicine Creates New Compliance Issues for Healthcare Providers

The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use. In April of 2019, the Centers of Medicare and Medicaid Service (CMS) finalized rules to increase telehealth benefits for Medicare Advantage enrollees, effectively incentivizing health systems with high numbers of private Medicare plan recipients to invest in telehealth services. More >

Healthcare Providers Take Notice: AMA Updates E/M Codes for 2021

In addition to staying up to date on the constantly changing landscape of COVID-19 requirements, healthcare providers must also stay well-informed of industry changes unrelated to the pandemic. On January 1, 2021, changes in Evaluation and Management (‘E/M’) codes for physicians took effect. These changes, proposed by the Centers for Medicare & Medicaid Services (‘CMS’), primarily impact 2021 Medicare Physician Fee Schedule (‘MPFS’) reimbursements. More >

Malnutrition Diagnosis Codes: The Compliance Danger You’re Not Taking Seriously Enough

It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks. More >

CMS Suspends the Advance Payment Program and Reevaluates Accelerated Payments

On April 26, 2020, the Centers for Medicaid & Medicare Services (CMS), announced that the Advance Payment Program for Part B suppliers was ending immediately and that the amounts being paid under the Accelerated Payment Program will be reevaluated. Going forward, new applications for the Advanced Payment program will not be accepted.  There are interesting implications and questions for providers who received funds under this program going forward as CMS has not issued any guidance concerning how this will be handled. More >

Coronavirus: Section 1135 Waivers Bring Relief to Healthcare Providers

Invoking powers under the National Emergency Act and the Stafford Act on March 13, 2020, the President declared a national emergency, which, in turn, authorized the Secretary of Health and Human Services to waive conditions of participation requirements for payment for healthcare providers through waivers provided under Section 1135 of the Social Security Act.  The 1135 waivers do not replace 1115 waivers that require states to individually submit requests for waiver of selected Medicaid requirements, but the 1135 waivers are designed to temporarily give healthcare providers more flexibility in providing services during the pandemic crisis. The 1135 waiver is very helpful but does not address all situations or answer all questions, and it creates ambiguity in certain circumstances.   More >

Kentucky Hospitals - Need Additional Acute Care Beds? It Can be Done

Given the recent predictions for an increase in the need for access to additional acute care beds, Kentucky hospitals have the option to seek emergency approval from the Kentucky Office of Inspector General's Division of Certificate of Need for operating these beds. The process is relatively simple, but requires affidavits that meet regulatory specifications. More >

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