News & Analysis as of

Medicare Physician Medicare Reimbursements

Dentons

Ep. 32 – An Easy Audit Tip to Help Avoid Overpayments

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Looking for a simple, easy-to-implement way to lower your risk of overpayments? We have one on this week’s podcast!...more

Sheppard Mullin Richter & Hampton LLP

Key Telehealth Updates in the CY 2025 Physician Fee Schedule Proposed Rule

On July 31, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (“Proposed Rule”) for the 2025 Medicare Physician Fee Schedule, which includes implications for telehealth services reimbursable...more

Nelson Mullins Riley & Scarborough LLP

Physicians Face Proposed Medicare Reimbursement Cuts for 2025 (RIN 0938-AV33)

Physician Fee Schedule Faces Cuts in CY25 - Overall Medicare payments to physicians and clinicians would be cut by a proposal to decrease average base payment rates by 2.93% from calendar year 2024 under a proposed rule...more

Dorsey & Whitney LLP

The Supreme Court Update - June 10, 2024

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Today, the Supreme Court of the United States granted certiorari in two cases: Facebook v. Amalgamated Bank, No. 23-980: This securities law case arises from a shareholder lawsuit against Facebook, which claimed Facebook...more

Oberheiden P.C.

What Does it Take to Win Medicare Appeals in 2024?

Oberheiden P.C. on

Lots of health care service providers find themselves in the position of needing to file a Medicare appeal. Despite the systematic nature of modern Medicare billing, wrongful denials remain common, and errors during Medicare...more

Holland & Knight LLP

CMS Previews Changes to Medicare Advantage Capitation Rates, Parts C and D Payment Policies

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies on Jan....more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - November 2023 #2

News Briefs - Lawmakers Reintroduce Healthcare Workforce Resilience Act - Federal lawmakers are trying again to push through immigration reform that would allow officials to recapture unused visas and reprocess them for...more

Nelson Mullins Riley & Scarborough LLP

OIG Issues Unfavorable Opinion About Bundling Free Items with Reimbursable Services

On Oct. 25, 2023, the Office of Inspector General (OIG) for the Department of Health and Human Services (DHHS) issued an unfavorable opinion in response to a manufacturer’s proposal to offer and provide a free compatible...more

Alston & Bird

Health Care Week in Review: CMS Releases Three Major Medicare Final Rules

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Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies,...more

Holland & Knight LLP

Holland & Knight Health Dose: October 24, 2023

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. ...more

Sheppard Mullin Richter & Hampton LLP

CMS Announces Proposed Rule for 2024 Medicare Physician Fee Schedule

On July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Physician Fee Schedule (“PFS”). The Proposed Rule, which was issued in the Federal...more

Quarles & Brady LLP

The Current State of 340B and What to Expect in 2023

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2022 was an eventful year on the 340B front, packed with updates to consequential litigation, proposed new rules, ongoing uncertainty into the Health Resources and Services Administration's (HRSA) underlying enforcement...more

Benesch

Dialysis & Nephrology Digest - January 2023

Benesch on

Federal omnibus spending bill rolls back some Medicare payment cuts scheduled for 2023, 2024 - Buried within the $1.7-trillion spending package signed by the President on Dec. 29 was partial relief for a planned 4.5% cut...more

Foley & Lardner LLP

Migraine Company Fails to Avoid Own Headache: Jet Medical and Others to Pay $745,000 to Resolve Allegations that Medical Device...

Foley & Lardner LLP on

On January 4, 2023, the Department of Justice issued a press release stating that Jet Medical Inc. has agreed to pay $200,000 to resolve criminal allegations relating to a migraine headache treatment. Jet Medical and two...more

Sheppard Mullin Richter & Hampton LLP

Key Healthcare Provisions of the Consolidated Appropriations Act, 2023

Introduction On December 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (the “Act”). The Act provides for nearly $1.7 trillion in funding across a range of domestic initiatives, including certain...more

Holland & Knight LLP

Holland & Knight Health Dose: December 13, 2022

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Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. This week's topics include: ...more

Bass, Berry & Sims PLC

Summary of Medicare Drug Negotiation Program in Inflation Reduction Act and Impact on Pharmacies and Providers

Bass, Berry & Sims PLC on

The U.S. House of Representatives is expected today to pass legislation passed by the U.S. Senate that will significantly alter the landscape for pharmaceutical pricing and reimbursement under the Medicare program for certain...more

Oberheiden P.C.

DOJ Announces Criminal Charges in Alleged $1.2 Billion Health Care Fraud Scheme

Oberheiden P.C. on

Yesterday, the U.S. Department of Justice (DOJ) announced that it has filed charges against 36 defendants in relation to an alleged health care fraud scheme that resulted in approximately $1.2 billion in fraudulent payments....more

Miller Canfield

Supreme Court Signals Move Away from Judicial Deference to Administrative Agencies

Miller Canfield on

Key Takeaways - ..In three decisions released late last month, the U.S. Supreme Court demonstrated increased skepticism of judicial deference to administrative agencies' statutory interpretations. ..While the...more

K&L Gates LLP

Health Care Triage: The Drive to Align ESG and Health Equity Priorities With Medicare Reimbursement Models

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Steve Pine and Alexa Sengupta address the Centers for Medicare and Medicaid Services’ emerging focus on ESG and health equity priorities, and how these priorities are impacting health data collection and Medicare value-based...more

Miles & Stockbridge P.C.

Anesthesiologists Potentially “Pinged” for Checking Their Phones During Surgery

The federal False Claims Act results in a host of interesting relator claims. This one caught my eye. In United States of America v. Intermountain Healthcare, Inc., Case No. 2:20-cv-00372-TC-CMR (U.S. Dist. Ct. D. Utah...more

Polsinelli

Positive Momentum Behind Congressional Efforts to Avert Medicare Cuts

Polsinelli on

Health Care providers have been advocating for Congress to avert a series of impending Medicare reimbursement cuts slated to take effect in January of 2022 – an issue that has garnered bipartisan support. Congressional...more

King & Spalding

OIG Issues Favorable Advisory Opinion Regarding Chiropractor Arrangement to Offer Discounts

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On September 30, 2021, OIG posted Advisory Opinion No. 21-14 regarding a chiropractor’s proposal to extend an existing discount program covering a package of services to include federal health care program beneficiaries. OIG...more

White & Case LLP

HHS Report Reiterates Biden Administration Support for Wide-Ranging Action to Address Drug Prices

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On September 9, 2021, the Department of Health and Human Services ("HHS") released its widely anticipated "Comprehensive Plan for Addressing High Drug Prices." The HHS report supports far-reaching legislative and...more

Morgan Lewis - Health Law Scan

Flawed Formula Drives Academic Medical Center Underpayments; Impacted Hospitals Should Consider Preserving Right to Payment

In the complex world of Medicare reimbursement, there are a multitude of payment formulae, mathematical adjustments, and reimbursement calculations that translate congressional policy into operational payments for hospital...more

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