Michael Cassidy on Healthcare

Procedural History of UPMC – Highmark Litigation

Below is a summary of UPMC-Highmark dispute as of February 22, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations....more

2/25/2019 / Class Action , Consent Decrees , Healthcare , Highmark , Legal History , Medicare Advantage

SGR Fix Already Revised and Hospital Outpatient Department $$ Reduced

The ink was barely dry on the Medicare Physician Sustainable Growth Rate (SGR) fix, and it has already been changed. One component of the SGR fix, which was just passed in April of this year, was freezing Medicare...more

11/4/2015 / Healthcare , Hospitals , Medicare , Physician SGR Formula , Sustainable Growth Rate (SGR)

Blue Cross of Northeastern Pennsylvania Denied Peer Review Protection

The Pennsylvania Superior Court has decided the Pennsylvania Peer Review Protection Act does not apply to alleged peer review activity conducted by Blue Cross of Northeastern Pennsylvania, because Blue Cross is not a...more

9/2/2015 / Blue Cross , Health Care Providers , Healthcare , Hospitals , Peer Review

CMS Stark Proposals Allow “Holdover” Arrangements and Signature Window

In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. The full text of these proposal and CMS comments and explanations is available below....more

8/20/2015 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Exceptions , Health Care Providers , Healthcare , Physicians , Proposed Regulation , Stark Law

CMS Limits Scope of Review for MACs

CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the...more

8/20/2015 / Administrative Appeals , Centers for Medicare & Medicaid Services (CMS) , Healthcare , MACs , QICs

CMS Clarifies Written Agreement Requirement

CMS has acknowledged that arrangements among providers to satisfy the Stark exceptions need not be created in a single document. Although a single written document memorializing the key facts of an arrangement could provide...more

8/17/2015 / Centers for Medicare & Medicaid Services (CMS) , Contract Drafting , Health Care Providers , Healthcare , Stark Law

CMS Proposes New Stark Exceptions: Timeshare Lease

In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. Over the next few days, I will post comment on what I consider the most significant new...more

8/14/2015 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Exceptions , Healthcare , Hospitals , License Agreements , Physician Ownership , Stark Law

CMS Proposes New Stark Exception: Recruitment of Non-Physician Practitioners

In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. Over the next few days, I will post comments on what I consider the most significant new...more

8/13/2015 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare , Hospitals , Nurse Practitioners , Nurses , Recruitment Policies , Rural Health Care Providers , Stark Law

CMS Announces One Year Partial ICD-10 Relief for Physicians

By now, everyone knows ICD-10 coding starts October 1, 2015. Starting October 1, 2015, Medicare claims with dates of service after October 1, 2015 will only be accepted if they contain a valid ICD-10 code. The Medicare...more

8/4/2015 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , ICD-10 , Medicare

Telehealth News

Iowa Supreme Court Rejects Ban on Telemedicine Abortions - An Iowa Board of Medicine rule requires the presence of a physician when abortion inducing drugs are provided....more

7/14/2015 / Abortion , Discrimination , Healthcare , Medicare , Physician Fee Schedule , Physicians , Planned Parenthood , Prescription Drugs , State Medical Board , Telehealth

TelaDoc Wins Injunction Against Texas Medical Board re: Telehealth Restrictions

The Federal District Court of the Western District of Texas has ruled against the Texas Medical Board and granted TelaDoc’s Motion for a Preliminary Injunction prohibiting the Texas Medical Board from enforcing new rules...more

6/22/2015 / Healthcare , In-Person Exam , Physicians , Preliminary Injunctions , Prescription Drugs , Standard of Care , State Medical Board , Telehealth

Colorado Approves Direct Medicare Payment to CRNA’s

Medicare Regulations allows CRNA’s to administer anesthesia without physician supervision if the state governor opts out of the regular physician supervision requirement. Governor Ritter of Colorado opted out in 2010,...more

6/22/2015 / Healthcare , Medicare , Nurses

Pennsylvania Introduces Telehealth Bill

House Bill 706 has been introduced in the Pennsylvania House. This is a “parity” bill which does the following: It defines telehealth in such as way as to neither mandate nor prohibit asynchronous or synchronous...more

6/4/2015 / Health Care Providers , Health Insurance , Healthcare , Pending Legislation , Telehealth

Peer Review Privilege: Facts vs. Conclusions

All states have some degree of confidentiality protection for peer review activities and the information generated by those activities, and there is additional federal protection for information gathered and created by...more

5/15/2015 / Confidential Communications , Health Care Providers , Healthcare , Hospitals , Peer Review , Physicians

Congress Repeals Medicare Sustainable Growth Rate (SGR)

MGMA has published the following alert: Congress repeals SGR! In a significant victory for physician group practices and MGMA, late last night the Senate voted (92-8) to approve the Medicare Access and CHIP...more

4/16/2015 / Children's Health Insurance Program (CHIP) , Healthcare , Medicare , New Legislation , Physician SGR Formula , Physicians

News from MGMA re SGR Repeal

Historic SGR repeal passes in House - Today, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act, H.R. 2, by a vote of 392–37. This legislation permanently repeals the SGR and returns...more

3/27/2015 / Children's Health Insurance Program (CHIP) , Healthcare , Medicare , Pending Legislation , Physician SGR Formula , Physicians

No SGR Action by Senate

Senate leaves for recess with no action on SGR repeal - Despite a successful vote in the House yesterday, the Senate failed to bring to a vote legislation to repeal the flawed Medicare Sustainable Growth Rate (SGR)...more

3/27/2015 / Healthcare , Legislative Agendas , Medicare , Physician SGR Formula , Physicians , Repeal

Ohio Proposes New Telehealth Prescribing Regulations

The Ohio State Medical Board has proposed new telehealth prescribing regulations, which are predicated upon whether the drug is a controlled or not a controlled substance....more

1/27/2015 / Controlled Substances , Health Care Providers , Healthcare , New Regulations , Prescription Drugs , State Medical Board , Telehealth

New York Passes Telehealth Bill

New York Governor Andrew Cuomo signed a Bill late last week, which will take effect as of January 1, expanding telehealth coverage in New York. This law does three things which are on the leading edge of telehealth coverage....more

1/13/2015 / Governor Cuomo , Health Insurance , Healthcare , Telehealth

Global Surgery and 2015 Medicare Physician Fee Schedule

On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery. On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and...more

12/3/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Medicare , Physician Fee Schedule , Physicians , Surgery

Face-to-Face Medicare Reimbursement Requirements for Home Health Certification

CMS has announced its concern regarding the level of compliance for documenting the face-to-face elements necessary for home health care certification....more

9/18/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Home Health Care , Physicians

CMS Designates Global Surgery as “Potentially Misvalued Services”

In the recently proposed 2015 Physician Fee Schedule, CMS devoted significant resources to discussing potentially misvalued services, which I believe is code for places where CMS would like to reduce reimbursement. One of the...more

7/22/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Physician Medicare Reimbursements , Surgery

CMS Seeking Comments Regarding Expanding Coverage for Secondary Interpretation of Images

In the proposed 2015 Medicare Physician Fee Schedule, CMS is seeking comments regarding expanding coverage for secondary interpretation of diagnostic imaging....more

7/22/2014 / Centers for Medicare & Medicaid Services (CMS) , Diagnostic Imaging Services , Healthcare , Physician Medicare Reimbursements

CMS Releases Proposed 2015 Physician Fee Schedule and Projects 20.9% SGR Reduction

CMS has issued the Proposed 2015 Physician Fee Schedule and Fact Sheets for specific issues (ASC, ESRD, Home Health, Physician Quality Programs)....more

7/16/2014 / Centers for Medicare & Medicaid Services (CMS) , Healthcare , Physician Fee Schedule , Physician SGR Formula , Physicians

OIG Report: Questionable Billing for Medicare Part B Clinical Laboratory Services

Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG –...more

7/11/2014 / Centers for Medicare & Medicaid Services (CMS) , Clinical Laboratories , Healthcare , Medicare , Medicare Part B , OIG

Michael Cassidy

Tucker Arensberg, P.C.

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