News & Analysis as of

Medicare Medicare Administrative Contractors (MAC)

Hogan Lovells

Tortoise and Hare: Congress may overtake CMS in years-long race to set Medicare breakthrough device coverage

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On June 27, 2024, the Ensuring Access to Breakthrough Products Act of 2024 (H.R. 1691) was marked up and reported out of the House Ways and Means Committee. This action brings Medicare beneficiaries one step closer to timely...more

Hendershot Cowart P.C.

A Pharmacist's Guide To Prescription Drug Fraud Investigations

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Prescription drug fraud has long been a focus for government regulators, but it has taken on new significance in the wake of America’s opioid crisis. The U.S. Department of Justice (DOJ), Department of Health and Human...more

Bass, Berry & Sims PLC

CMS Announces Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments to Part A Providers and Advance Payments to...

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Recognizing the ongoing impact of the cyberattack experienced by Change Healthcare/Optum on February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) announced over the weekend that it will allow Part A providers...more

Foley & Lardner LLP

“Let’s Talk Compliance”: Medicare Advantage: Compliance Issues and Enforcement

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Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more

Arnall Golden Gregory LLP

The Devil’s in the Details: Hospice Providers Face Claim Denials for Election Statement Technicalities

Since the Centers for Medicare & Medicaid Services (“CMS”) paused much of its audit activity during the COVID Public Health Emergency, the most recent rounds of Medicare audit activity may represent the first “look” at the...more

Arnall Golden Gregory LLP

CMS Announces Enhanced Oversight for New Hospices in Four States

Effective July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) announced a period of enhanced oversight for new hospices in Arizona, California, Nevada, and Texas. According to the Medicare Learning Network...more

Maynard Nexsen

Billing Medicare or Medicaid? Understanding Your Audit Risk

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If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit...more

Bass, Berry & Sims PLC

CMS Proposes $9 Billion Refund to 340B Hospitals and Reductions in Future Payments to All Hospitals for Non-Drug Services

Bass, Berry & Sims PLC on

On July 7, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to implement a remedy in response to last year’s Supreme Court decision finding the Medicare Part B payment policy for hospitals in the 340B...more

Maynard Nexsen

CMS Announces New “SNF 5-Claim Probe & Educate Review”

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On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new nationwide audit of all skilled nursing facilities (SNF) and Hospital swing bed providers that submit claims for reimbursement to Medicare...more

Wilson Sonsini Goodrich & Rosati

Medicare Contractors Buy Additional Time for the Digital Health Industry

The explosive growth in telehealth over the past five years has resulted from, among other things, the Centers for Medicare & Medicaid Services’ (CMS) extension of Medicare reimbursement to remote monitoring of patients by...more

King & Spalding

CMS Issues Guidance for Medicare Contractors to Pay For Section 1115 Day

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On March 16, 2023, CMS issued Change Request 12669, which contains instructions for Medicare Administrative Contractors (MACs) to begin the process of retroactively reimbursing DSH hospitals for inpatient days attributable to...more

McDermott Will & Emery

Remote Monitoring Services Under Review: Update on Potential Medicare Coverage Policies

A recent multijurisdictional contractor advisory committee (CAC) meeting held by six of the seven Medicare Administrative Contractors (MACs) gave stakeholders an initial opportunity to provide feedback on the strength of...more

Benesch

CMS Adds SNFs to “High” Screening Category, Greater Scrutiny of Change of Ownership and Provider Enrollment/Revalidation

Benesch on

The Centers for Medicare and Medicaid Services (“CMS”) has effectuated multiple changes that directly impact the acquisition, development, and revalidation of skilled nursing facilities that participate in the Medicare...more

McDermott Will & Emery

Remote Monitoring Services Under Review: Medicare Coverage Policies May Be Coming

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Six of the seven Medicare Administrative Contractors (MACs) are scheduled to jointly host a multijurisdictional contractor advisory committee (CAC) meeting on February 28, 2023. This CAC panel meeting will allow the MACs to...more

Foley & Lardner LLP

Medicare Remote Therapeutic Monitoring: Top FAQs for 2023

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On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) finalized new policies related to remote therapeutic monitoring (RTM) services reimbursed under the Medicare program. The changes, part of the...more

Nelson Mullins Riley & Scarborough LLP

Understanding the Medicare Overpayment Appeals Process

Every Medicare provider should understand the Medicare administrative appeals process. Providers are entitled to be reimbursed for their services and want to keep those reimbursements safe from audits. However, if Medicare...more

King & Spalding

OIG Recommends CMS Use OIG Hospital Compliance Audits to Enhance its Medicare Oversight

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On October 26, 2022, OIG published a report summarizing the results of 12 OIG hospital compliance audits covering Medicare claims paid from 2016 through 2018. OIG recommends, among other things, that CMS follow up on...more

Roetzel & Andress

Failing to Update Your Medicare Information Could Prove Costly

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The Centers for Medicare & Medicaid Services (CMS) requires Medicare providers and suppliers to keep their enrollment information up to date at all times. Changes in this information can affect claims processing, payment...more

Husch Blackwell LLP

Hospice Audit Series | It's That Time of Year Again: Quality Data Reporting Determinations Raise New and Recurring Issues

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Each July, the Medicare Administrative Contractors issue notices of a 2% Medicare payment reduction to those providers who did not meet quality data reporting requirements. Those notices have been sent. In this episode, Husch...more

Hogan Lovells

Panelists discuss present & future reimbursement mechanisms for AI health care products

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At our recent Health Care AI Law and Policy Summit, Hogan Lovells partner Stuart Langbein moderated a panel discussion on AI policy and reimbursement issues. Joined by representatives from CMS Medicare Administrative...more

Oberheiden P.C.

Medicare TPE Audits: 6 Things You Need to Know

Oberheiden P.C. on

Targeted Probe and Educate (TPE) audits have recently become a common tool used by both law enforcement and private insurers in the Medicare program. While they focus on educating Medicare providers about proper billing...more

Arnall Golden Gregory LLP

CHOW Considerations for Medicare Chain Providers: The Importance of Knowing Your MAC

All Medicare providers must update their enrollment information to reflect changes in ownership (CHOWs) within 30 days after the CHOW. Providers must report CHOWs to the applicable Medicare Administrative Contractor (MAC)....more

Foley & Lardner LLP

Cardiac Medical Device Medicare Overpayment Self-Assessment – Methodology

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More than 900 hospitals across the United States are approaching a Centers for Medicare & Medicaid Services (CMS)-imposed deadline to report overpayments from the removal (explant) of defective cardiac medical devices if...more

King & Spalding

CMS Announces Repayment of COVID-19 Accelerated and Advance Payments

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On April 1, 2021, CMS announced that it began recovering COVID-19 Accelerated and Advance Payments (CAAPs) from Medicare providers and suppliers as early as March 30, 2021. Repayments begin one year from the date CMS...more

King & Spalding

Federal Court Affirms Denial of Medicare Payment for Inpatient On-Call Services to Critical Access Hospital

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On March 31, 2021, Judge Carl Nichols of the United Stated District Court for the District of Columbia issued a decision upholding CMS’s denial of reimbursement to a California Critical Access Hospital (CAH) for compensation...more

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