Healthcare Law Blog

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 >

Vaccination Mandate for Healthcare Facilities Blocked by Federal Court

The Centers for Medicare and Medicaid Services (CMS) Interim Final Rule which would have required COVID-19 vaccination for employees of healthcare facilities that receive Medicare and/or Medicaid funding has been blocked by a federal court in Louisiana. Here’s what healthcare employers need to know. 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On July 19, 2021, the Center for Medicare and Medicaid Services (“CMS”) rescinded a guidance issued in 2017 that significantly limited the discretion of CMS Locations to impose substantial fines for noncompliance.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 >

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 >

CMS Expands Accelerated and Advance Payment Program for COVID-19 Emergency

As part of the CARES Act, the Centers for Medicare & Medicaid Services (CMS) has expanded the Accelerated and Advance Payment Program to a larger group of Part A providers and Part B suppliers. The full fact sheet on the expansion is available from CMS here, but we’ve summarized the significant points below. 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 >

New Telehealth Expansion May Benefit Healthcare Entities

Telehealth may be the answer to sustaining rural health care, hospital outpatient services, and primary care during the COVID-19 health crisis. With the CMS announcement on March 17th of how it will pay for telehealth, delineation of the codes, and major changes for patient location requirement, all rural health clinics, physician practices that provide MAT, primary care practices, federally qualified health care centers, and hospital outpatient departments should immediately review the expansion of telehealth coverage and determine how practices and clinics can benefit from the relaxed requirements and how these services can be quickly implemented.

Also, on March 19, the Cabinet for Health and Family Services expanded Medicaid services to include “any appropriate health service related to or rationally related to the declared emergency” and telehealth services which may include the use of a telephone. This new regulation temporarily suspends certain income and institutionalization restrictions. The regulation also expands its reach to services provided under WIC. These changes will have a corresponding effect on Medicaid coverage and payments.

Implementation of a telehealth program requires careful consideration of the requirements and new policies and procedures.  Also, all services regardless of ambiguous government guidance must be well documented.

Telehealth may be the way to provide services and protect health care providers.  Let us know if McBrayer can be of assistance.  The CMS fact sheet related to the telehealth expansion can be found here. 

Lisa English Hinkle is a Member of McBrayer law. Ms. Hinkle chairs the healthcare law practice and is located in the firm’s Lexington office. Contact Ms. Hinkle at lhinkle@mcbrayerfirm.com or (859) 231-8780, ext. 1256, or reach out to any of the attorneys at McBrayer. 

Services may be performed by others.

This article does not constitute legal advice.

CMS Executes About-Face on Pre-Dispute Arbitration Ban

The Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule on June 5, 2017, that serves as an effective course reversal on pre-dispute arbitration agreements in a long-term care (“LTC”) setting. This caps off an effort by many in the healthcare and nursing home industry to stop the prior rule, which banned such agreements, from taking effect. More >