Tesch Leigh West

Tesch Leigh West

Morgan Lewis

Contact
View Bio
RSS

Latest Posts › Centers for Medicare & Medicaid Services (CMS)

Share:

Risk Adjustment Continues to be A Major Focus in Medicare Advantage

Medicare Advantage is the dominant Medicare delivery system, now covering 54% of all Medicare enrollees. With the increase in enrollment and federal spending, however, has come increased scrutiny from enforcement and...more

4/18/2025  /  Centers for Medicare & Medicaid Services (CMS) , Department of Justice (DOJ) , Enforcement Actions , False Claims Act (FCA) , Government Agencies , Healthcare Fraud , Medicare Advantage

Falling Stars Ratings in Medicare Advantage Lead to Meteoric Payment Losses

The enormous impact of Medicare Stars Ratings on payments received by Medicare Advantage plans cannot be overstated. And with billions of dollars in bonus payments at stake, it may come as no surprise that stringent standards...more

12/2/2024  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

Unpackaging CMS’s HOPPS Proposed Rule and Payments for Diagnostic Radiopharmaceuticals

In what can only be characterized as a necessary but significant proposed departure from current political initiatives focused on lowering pharmaceutical drug prices, the Centers for Medicare & Medicaid Services (CMS)...more

7/23/2024  /  Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Medicare , Medicare Part B , Pharmaceutical Industry , Prescription Drugs

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

Medicaid Unwinding: CMS to Withhold Federal Medicaid Funding from Noncompliant States

Since our publication on disenrollments caused by the “unwinding” of Medicaid’s continuous enrollment condition, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on December 6, 2023...more

12/20/2023  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Interim Final Rules (IFR) , Medicaid

Don’t Wait to Review CMS’s Proposal to Implement Minimum Managed Care Appointment Wait Times

The Centers for Medicare & Medicaid Services (CMS) proposed on April 23, 2023 two rules that would affect Medicaid managed care: Ensuring Access to Medicaid Services (CMS 2442-P) and Medicaid and Children’s Health Insurance...more

6/29/2023  /  Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Managed Care Contracts , MCOs

Medicaid Changes Now and Later: What to Expect at the End of the PHE and Beyond

Medicaid enrollment grew significantly during the public health emergency (PHE). States implemented expanded eligibility and enrollment as well as reduced cost sharing and premiums based on Medicaid program regulatory...more

5/11/2023  /  Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Families First Coronavirus Response Act (FFCRA) , Medicaid , Public Health Emergency , Telehealth

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

CMS’s Final RADV Rule Announces No Extrapolation Methodology, No FFS Adjuster

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs) and...more

2/24/2023  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

CMS’s Delayed Final Rule on the FFS Adjuster Gets Delayed . . . Again

The Centers for Medicare & Medicaid Services (CMS) delayed the publication of the final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation...more

11/14/2022  /  Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Final Rules , Health Care Providers , Medicare Advantage Organizations (MAOs)

February Fast Break Recap: Risk Adjustment and Liability

Last month, we had an engaging Fast Break session covering the growing importance of risk adjustment in various health insurance programs and novel government theories of liability associated with risk adjustment reporting....more

3/16/2022  /  Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Insurance , OIG

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
12 Results
 / 
View per page
Page: of 1

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up Log in
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide