Jacob Harper

Jacob Harper

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Medicare Advantage: Managed Care Compliance in 2024

The Medicare program is broken down into four parts. Part A covers the cost of healthcare items and services provided during inpatient hospital stays as well as skilled nursing facility, hospice, and some home health care....more

3/21/2024  /  Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Medicare , Medicare Advantage , Prescription Drugs

Medicare’s New Dementia GUIDE Model: How Can Physicians, Hospices, and Home Health Agencies Participate?

If you have had a loved one suffer from dementia, you know the emotional, physical, and financial toll of this terrible disease. With advancements in dementia treatment, however, there is renewed hope on addressing this...more

3/4/2024  /  Centers for Medicare & Medicaid Services (CMS) , Dementia , Health Care Providers , Home Health Care , Medicare

CMS Increases Hospice Scrutiny through Provider Enrollment and Oversight Tools

The US Centers for Medicare & Medicaid Services (CMS) has implemented a final rule, effective November 13, 2023, designed to enhance the oversight of hospice providers throughout the United States and increase regulatory...more

11/6/2023  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Physicians

How the End of the PHE Will Impact the Healthcare Industry

The Biden administration announced on January 30, 2023 that the COVID-19 Public Health Emergency (PHE) would officially end on May 11, 2023. The PHE declaration, which first was issued by the Secretary of the US Department of...more

5/11/2023  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Emergency Use Authorization (EUA) , Food and Drug Administration (FDA) , Life Sciences , Medicare , OCR , Public Health Emergency , Telehealth

Wake Me Up When the PHE Ends

Another year has come to pass, and it seems the federal Public Health Emergency (PHE) will remain in place for at least the next five months. Why? As the US Department of Health and Human Services (HHS) has continuously...more

11/21/2022  /  Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Public Health Emergency , Telehealth , Telemedicine

OIG Lauds UPIC Program and Recommends Expansion, Additional Targeting of Medicaid Providers

On October 3, the Office of Inspector General (OIG) of the US Department of Health and Human Services issued a report titled “UPICs Hold Promise to Enhance Program Integrity Across Medicare and Medicaid, But Challenges...more

10/14/2022  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicaid , Medicare , OIG

CMS Releases Physician Fee Schedule Proposed Rule, Continuing Emphasis on Equity and Value-Based Care

The Centers for Medicare & Medicaid Services on July 7 released its proposed rule for the Medicare physician fee schedule for Calendar Year 2023. Among other updates, the proposed rule contains significant programmatic...more

7/12/2022  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Shared Savings Program , Physician Fee Schedule , Physicians , Proposed Rules

OIG Launches New Resource Page Featuring Telehealth

Perhaps signaling the increasing likelihood of a permanent telehealth solution for the Medicare program, the Office of Inspector General for the US Department of Health and Human Services (OIG) has established a “Featured...more

4/7/2022  /  Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , OIG , Social Security Act , Telehealth , Telemedicine

August Fast Break Recap – CMS Telehealth and RPM Updates

We hosted a very informative Fast Break session last month on CMS telehealth and RPM updates. If you weren't able to join us, the session was led by healthcare litigation associates Jake Harper and Tesch West, with special...more

9/10/2021  /  Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Rules , Telehealth , Telemedicine

Tele-Tuesday: OIG Clarifies Stance on Telehealth Fraud Scrutiny

The US Department of Health and Human Services Office of Inspector General (OIG), the Department of Justice (DOJ), and other federal regulators have grown increasingly concerned about the use of telehealth technologies by...more

3/2/2021  /  Health Care Providers , Healthcare Fraud , Medicaid , Medicare , OIG , Patient Access , Prescription Drugs , Public Health Emergency , Telehealth

Tele-Tuesday: Executive Order Signals Increased Support for Telehealth Expansion

US President Donald Trump issued an executive order on August 3 that aims to expand telehealth access to Medicare beneficiaries beyond the coronavirus (COVID-19) public health emergency (PHE) period. ...more

8/5/2020  /  Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Executive Orders , Health Care Providers , Medicare , Patient Access , Relief Measures , Telehealth , Telemedicine , Trump Administration

CMS Expands Hospice Flexibilities to Fight COVID-19

CMS posted an expanded set, dated April 29, of Medicare regulatory flexibility measures for hospice organizations related to the coronavirus (COVID-19) pandemic, supplementing the previous COVID hospice flexibilities guidance...more

5/8/2020  /  Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Hospice , Medicare , Quality Assurance Programs , Relief Measures , Telehealth

CMS Issues Sweeping Telehealth Interim Final Rule in Response to COVID-19 Crisis

The Center for Medicare and Medicaid Services (CMS) released a far-reaching interim final rule (IFR) to address the coronavirus (COVID-19) pandemic on March 30. The IFR represents a comprehensive set of policy changes...more

4/7/2020  /  CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Medicare , Public Health Emergency , Relief Measures , Telehealth , Telemedicine

CMS Implements Massive Rule Change To Bolster Telehealth Amid COVID-19: What Providers Need To Know To Serve Their Patients

On March 30, 2020, the Centers for Medicare & Medicaid Services released a stunning and far-reaching interim final rule to address the coronavirus (COVID-19) crisis. The rule is a comprehensive set of policy changes designed...more

4/7/2020  /  Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Interim Final Rules (IFR) , Medicare , Relief Measures , Telehealth , Telemedicine

HHS to Exercise Enforcement Discretion in Response to CMS Telehealth Waiver

As we noted in our previous Health Law Scan blog CMS Issues Program Instructions for Medicare Telehealth Waiver, CMS issued program instructions on March 17 to implement the Medicare telehealth waiver in response to the...more

3/20/2020  /  Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Facebook , FaceTime , Health Insurance Portability and Accountability Act (HIPAA) , Medicare , OCR , OIG , Public Health Emergency , Skype , Telehealth , Waivers

CMS Issues Program Instructions for Medicare Telehealth Waiver

CMS issued program instructions on March 17 (through a Fact Sheet and FAQ) to implement the Coronavirus Preparedness and Response Supplemental Appropriations Act (CPRSAA), which was enacted on March 6 in response to the...more

3/18/2020  /  Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Emergency Response , Health Care Providers , Health Insurance Portability and Accountability Act (HIPAA) , Medicare , OCR , Physicians , Public Health , Relief Measures , Telehealth , Telemedicine , Waivers

Tele-Tuesday: Congress’s Coronavirus Bill Includes Major Telehealth Changes

As part of emergency funding to combat the threat of the 2019 Novel Coronavirus (COVID-19), last week Congress waived many of the telehealth restrictions for Medicare services in certain situations. This monumental change...more

3/10/2020  /  Anti-Kickback Statute , Coronavirus/COVID-19 , Crisis Management , Emergency Management Plans , Emergency Response , Federal Funding , Health and Safety , Health Care Providers , Infectious Diseases , Legislative Agendas , Medicare , Policies and Procedures , Public Health , Stark Law , Telehealth

Mere Differences of Judicial Opinion Emerge to Muddle Healthcare Providers False Claims Act Exposure for Mere Differences of...

In the Care Alternatives False Claims Act (FCA) appeal, a panel of the US Court of Appeals for the Third Circuit on March 4 reversed the summary judgment granted to hospice provider Care Alternatives at the district court,...more

3/6/2020  /  Appeals , Cooperative Compliance Regime , Department of Justice (DOJ) , Eligibility Determination , Enforcement Actions , False Claims Act (FCA) , Fraud and Abuse , Health Care Providers , Healthcare Facilities , Healthcare Fraud , Hospice , Medicare , Medicare Billing Privileges , Qui Tam , Reversal , Risk Management , Whistleblowers

MedPAC Recommends Medicare Payment Reductions for Hospice and Home Health

The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, recently finalized and approved a series of recommended updates on January 16 that include payment reductions for hospice and home...more

1/22/2020  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospice , Medicare , MedPAC

Telephone Hearing Demonstration at the Reconsideration Level: Now Open to Home Health and Hospice

Continuing to look for ways to reduce the Medicare administrative law judge (ALJ) appeals backlog, CMS has explored enhancing the role of Qualified Independent Contractors (QICs) to resolve disputed claims earlier in the...more

12/20/2019  /  Administrative Law Judge (ALJ) , Centers for Medicare & Medicaid Services (CMS) , Hospice , Medicare , Qualified Independent Contractors (QIFs)

Ready to CONNECT? Telehealth Is Here to Stay

With bipartisan bills introduced in both the US House of Representatives and the US Senate on October 30, Congress appears ready to expand access to telehealth benefits for Medicare beneficiaries. The Creating Opportunities...more

11/1/2019  /  Department of Health and Human Services (HHS) , Health Care Providers , Medicare , Telehealth

Fast Break: Physician Fee Schedule Update

Eric Knickrehm discusses the important changes the proposed Physician Fee Schedule rule would have on Medicare Part B. Provided below is an overview of the most important aspects of the proposed rule, which was published...more

9/13/2019  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Implementation Day , Medicare , Opioid , Physician Fee Schedule , Physicians

Tele-Tuesday: Top Five Telehealth Legal Issues for Summer 2019

Summer is almost upon us. And in between the BBQs, pool parties, and baseball games, you might be trying to understand the risks involved in offering healthcare services through telehealth. Whether you're an independent...more

6/11/2019  /  Digital Health , Healthcare Fraud , Medicare , Medicare Advantage , Telehealth

Tele-Tuesday: A Closer Look at the Medicare Advantage Telehealth Flex Rule

CMS finalized a rule last month that will significantly expand access to telehealth services for patients in Medicare Advantage plans. Implementing provisions of the Bipartisan Budget Act of 2018 (BiBA), the new rule will...more

5/14/2019  /  Bipartisan Budget Act , Centers for Medicare & Medicaid Services (CMS) , Digital Health , Medicare , Medicare Advantage , Telehealth

Something Old, Something New: The Proposed Medicare Physician Fee Schedule Rule

Mixing innovative change with standing policy, the proposed physician fee schedule rule for CY 2019 highlights a Medicare payment system in transition. Clinicians and groups focused solely on driving volume without devoting...more

7/25/2018  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Physician Fee Schedule , Physicians
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