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Hospitals Centers for Medicare & Medicaid Services (CMS) Medicare Part A

Bass, Berry & Sims PLC

CMS Finalizes New Mandatory Value-Based Payment Initiative: The Transforming Episode Accountability Model

Bass, Berry & Sims PLC on

On August 28, as part of its Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the Transforming Episode Accountability Model (TEAM)...more

King & Spalding

OIG Report Details Weaknesses in Enforcement of Two-Midnight Rule

King & Spalding on

CMS estimates that between 2017 and 2021, Medicare Part A improperly paid $23.9 billion for inpatient hospital stays, with $7.8 billion attributable to short stays that did not qualify for Medicare Part A. On June 13, 2024,...more

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - March 2024

Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more

Holland & Knight LLP

Holland & Knight Health Dose: October 17, 2023

Holland & Knight LLP on

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

King & Spalding

OIG Announces Results of Hospital Transfer Payment Policy Audit

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On Friday, October 6, 2023, OIG announced the results of an audit performed on the Medicare Part A hospital transfer policy for discharges to post-acute care (PAC). The hospital transfer policy, which was established in...more

McDermott+

Overall Medicare Hospital Payments Will Increase in FY 2024, but Some Hospitals Could See a Decrease

McDermott+ on

Congress may be on summer break, but reg season is in full swing. Last week, the Centers for Medicare & Medicaid Services (CMS) released a final reg that will impact Medicare hospital payments in fiscal year (FY) 2024, which...more

Foley & Lardner LLP

CMS Issues Final Rule Extending and Revising Comprehensive Care Joint Replacement Episode-Based Payment Model

Foley & Lardner LLP on

The Centers of Medicare and Medicaid Services (CMS) issued a Final Rule (the Rule) on April 29, 2021 extending and making various revisions to the Comprehensive Care for Joint Replacement Model (the CJR Model). The CJR Model...more

King & Spalding

CMS Issues Medicare IPPS and LTCH Proposed Rule for FY 2021

King & Spalding on

On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more

Health Care Compliance Association (HCCA)

CMS offers correct billing tips for nonphysician outpatient services provided before or during inpatient stays

Compliance Today (March 2021) - The Centers for Medicare & Medicaid Services (CMS) has provided the following compliance notice: “In a recent report, the Office of Inspector General (OIG) determined that Medicare made...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 8. News Briefs: March 2021

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - According to a CMS spokesperson, “CMS has not yet determined when Targeted Probe and Educate reviews will resume.” Meanwhile, “CMS continues to temporarily pause...more

McGuireWoods Consulting

Washington Healthcare Update - November 2020 #1

McGuireWoods Consulting on

This week in Washington: Washington’s focus has been on the presidential and Senate races....more

Chambliss, Bahner & Stophel, P.C.

CARES Act Provider Relief Fund

Today, the Department of Health and Human Services (HHS) announced the delivery of the initial $30 billion tranche from the $100 billion provider relief fund established under the Coronavirus Aid, Relief, and Economic...more

Seyfarth Shaw LLP

Health CARES - Title III of the CARES Act Impact on Long Term Care Facilities

Seyfarth Shaw LLP on

Congress passed and the President signed the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. 116-136) (“CARES Act”) on March 27, 2020.  We recently provided guidance on how the CARES Act impacts hospitals.  ...more

Jackson Walker

Immediate Financial Assistance for Medicare Part A and Part B Providers

Jackson Walker on

The Centers for Medicare & Medicaid Services (CMS) has expanded its accelerated and advance payment program to provide immediate interest-free cash support to Medicare providers during the COVID-19 public health emergency. ...more

Goodwin

CMS Expands Availability Of Advances On Medicare Reimbursement; U.S. Cares Act Increases Medicare Reimbursement Rates

Goodwin on

In response to the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) announced on Saturday March 28, 2020, that it is expanding its Medicare Accelerated and Advance Payment Program (AAPP) to...more

Seyfarth Shaw LLP

Health CARES – The CARES Act Impact on Hospitals

Seyfarth Shaw LLP on

As reported in Seyfarth’s April 2, 2020 COVID-19 Update, the Coronavirus Aid, Relief, and Economic Security Act (Pub. L. 116-136) (“CARES Act” or “Act”)...more

McDermott Will & Emery

CMS Releases Fact Sheets on COVID-19 Medicare Coverage, Billing Guidelines

McDermott Will & Emery on

The Centers for Medicare and Medicaid Services (CMS) released several fact sheets on COVID-19 coverage and benefits, and announced a second Healthcare Common Procedure Coding System (HCPCS) code, U0002, for billing COVID-19...more

K&L Gates LLP

K&L Gates Triage: The Impact of Allina — Potential Limitation on CMS’s Ability to Recoup Overpayments

K&L Gates LLP on

In this week’s episode, Adam Cooper discusses the Supreme Court’s decision in Azar v. Allina Health Services, as well as a related memorandum issued in late 2019 by the Centers for Medicare and Medicaid Services (“CMS”) that...more

Morgan Lewis - Health Law Scan

HHS Analyzes Legal Impact of Allina on Agency Enforcement

The US Department of Health and Human Services (HHS) Office of General Counsel (OGC) offered the healthcare industry the benefit of its legal analysis of the recent US Supreme Court opinion in Azar v. Allina Health Services...more

Polsinelli

CMS Outlines New Standard for Challenging Medicare Payment Denials, Echoing Brand Memo on Force of Sub-Regulatory Guidance

Polsinelli on

On October 31, 2019, the Office of General Counsel for the U.S. Department of Health and Human Services (HHS) issued an important memo from Kelly M. Cleary, CMS Chief Legal Officer, and Brenna E. Jenny, Deputy General...more

King & Spalding

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

King & Spalding on

Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more

Brownstein Hyatt Farber Schreck

Medicare Rulemaking After Azar v. Allina Health Services

The Medicare Program, established in 1965, initially seemed simple: provide health care for senior citizens by paying hospitals and doctors directly for the care the seniors required. Initially, there were two parts to...more

King & Spalding

Supreme Court Delivers Victory to Providers in Allina DSH Part C Case in a Decision with Broad Implications

King & Spalding on

In a major win for providers that serve a disproportionate share of indigent patients, the Supreme Court today upheld the D.C. Circuit’s earlier decision invalidating CMS’s policy to treat beneficiaries enrolled in Part C...more

Epstein Becker & Green

Supreme Court Expands the Scope of Public Participation in Medicare Policymaking

On June 3, 2019, the U.S. Supreme Court ruled in Azar v. Allina Health Services that the Medicare statute requires the Centers for Medicare & Medicaid Services (“CMS”) to engage in public notice-and-comment rulemaking...more

Mintz - Health Care Viewpoints

Supreme Court Decides Important Case on When CMS Must Use Formal Rulemaking when Instructing Medicare Contractors

On June 3, 2019, the U.S. Supreme Court issued a decision in Azar v. Allina Health Services. The case involved a challenge by hospitals over whether the Department of Health and Human Services (“HHS”) was required to proceed...more

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