A bipartisan group of senators has introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019. A summary produced by that bipartisan group is attached....more
Attached are links to the CMS Press Release and the Trump Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.
The Trump Executive Order was first issued on June 21,...more
As another part of the Regulatory Sprint to Coordinated Care, OIG proposed revisions to the existing EHR Anti-Kickback Safe Harbor and added a cybersecurity component.
The initial EHR Safe Harbor was developed in response...more
On October 22, 2019, CMS and OIG (Office of Inspector General) released new proposed rules regarding Stark Law Exceptions and Anti-Kickback Safe Harbors in response to what has universally been christened as the “Regulatory...more
11/7/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Exceptions ,
Health Care Providers ,
OIG ,
Physicians ,
Proposed Rules ,
Regulatory Requirements ,
Safe Harbors ,
Stark Law ,
Value-Based Care
HHS has long admitted that the Anti-Kickback Statute (AKS) and the Stark law have not evolved to keep pace with the transition to value based care. In June of 2018, HHS issued an RFI seeking additional information and HHS...more
The Patient Test Result Information Act was effective December 23, 2018.
The Act requires entities performing diagnostic imaging services, defined to include any medical imaging test intended to diagnose the presence or...more
On April 4, 2019, CMS issued the final Medicare Advantage Rule for calendar year 2020, announcing it will allow Medicare Advantage carriers to significantly increase the range of telehealth services beyond traditional...more
Although there have been a number of issues raised by the Pennsylvania Attorney General in the UPMC/Highmark situation, including UPMC’s status as a charitable institution, the primary issue in the Attorney General’s lawsuit...more
On Thursday, March 28, CMS issued a new MLN Connects article, which included updates for ambulatory surgery center payments. A link is attached below...more
Below is a summary of UPMC-Highmark dispute as of March 4, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations....more
3/4/2019
/ Affordable Care Act ,
Consent Decrees ,
Due Process ,
Employee Retirement Income Security Act (ERISA) ,
Equal Protection ,
Highmark ,
Legal History ,
Medicare ,
Medicare Advantage ,
Preemption ,
Preliminary Injunctions ,
Sherman Act ,
Takings Clause
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
As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019.
CMS explained...more
In October 2018, the National Practitioner Data Bank (NPDB) published the third edition of the NPDB Guidebook.
NPDB publishes monthly “NPDB insights”. I could not send the link to that, but I have attached a copy of the...more
“Eliminating Kick-Backs and Recovery Act of 2018” (EKRA) is a part of a group of laws recently passed by Congress to expand the law enforcement spectrum available to fight the opioid epidemic. EKRA is part of approximately 70...more
The final Medicare 2019 Physician Fee Schedule https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html rule was posted on November 1, 2019, to be effective January 1, 2019. It includes...more
The 2019 proposed Medicare Fee Schedule was published on July 27, 2018 by CMS at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf.
Pages 61 through 91 of the Executive Summary are devoted to:...more
Just as a point of providing information, please note that CMS has revised its Medicare Learning Network (MLN) booklet for telehealth services. The February 2018 edition is included in this link....more
A new Telemedicine Act is wending its way through the legislative process in Pennsylvania. Senate Bill 780 of 2017 (attached hereto as a PDF) has been unanimously passed by the Senate and referred to the House Professional...more
Peer Review Confidentiality will become much more complicated with the addition of economic evaluation to physicians’ quality and efficiency. Physicians will be surprised to learn that many “reviews” to which they may...more
On April 23, 2018, CMS issued a request for information on direct provider contracting models. In that request, (attached hereto as a PDF), CMS stated as follows...more
The Pennsylvania Supreme Court ruled, on March 27, 2018, in Regenelli v. Boggs, Monogahela Valley Hospital and UPMC/ERMI that physician performance reviews of an ER physician, who was provided by ERMI to Mon Valley Hospital,...more
Pennsylvania Act 70 of 2017, a copy of which is attached, changes the definition of an ambulatory surgical facility by redefining the duration of the “services” to be 24 hours, rather than a 4 hour procedure and 4 hours of...more
Although it has been almost a decade since the OIG has issued a gainsharing opinion, OIG Advisory Opinion No. 17-09 confirms the federal government’s support of the pay for performance concept.
OIG 17-09 is the first...more
On January 11, 2018, CMS announced a new voluntary episode payment model (bundled payments for care improvement advanced–BPCI Advanced) that will test a new iteration of bundled payment for the following thirty-two (32)...more
In the January 11, 2018 issue of MLN Connects, CMS has now widely publicized that it issued billing guidance for major joint replacements (hip or knee) in May 2017 at ICN909065.
CMS reports that major joint replacement is...more