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Hospitals Medicare Part B Medicare Part A

Bass, Berry & Sims PLC

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

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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

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

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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

Warner Norcross + Judd

Medicare Open Enrollment: Making Smart Choices for Rehabilitation Stays

Warner Norcross + Judd on

Medicare’s open enrollment period is just a few weeks away, and it is not too early to start thinking about your coverage options. One benefit area that Medicare recipients often overlook is long term rehabilitation coverage....more

Foley & Lardner LLP

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

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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

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

McGuireWoods Consulting

Washington Healthcare Update - November 2020 #1

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

Mitchell, Williams, Selig, Gates & Woodyard,...

Understanding Medicare

What does Medicare cover? What are the costs of Medicare? What happens if you forget to enroll for Medicare? Medicare is the federal health insurance program for people in the United States who are over the age of 65 or...more

McDermott Will & Emery

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

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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

King & Spalding

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

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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

Foley & Lardner LLP

Medicare Address Match: Hospital Outpatient Denials Looming

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Beginning in July, 2019, the Centers for Medicare & Medicaid Services (CMS) will direct Medicare Part A/B Macs to perform claim validation edits and return all claims to hospital providers if the address included on their...more

McGuireWoods Consulting

Washington Healthcare Update

McGuireWoods Consulting on

Congress - Senate - Senate Vote Fails to Block Trump Administration’s Short-Term Health Plans - On Oct. 10, the Senate failed to block the Trump administration’s expansion of short-term insurance plans. The...more

Epstein Becker & Green

HHS-OIG Work Plan – Medicare Advantage

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Providers, plans, and vendors that provide services under the Medicare Advantage program, should be aware that the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) is once again...more

Baker Donelson

OIG Finds Acute Care Hospitals Improperly Billed for Outpatient Services Provided to Inpatients of Other Hospitals

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Acute care hospitals that provide Medicare outpatient services to inpatients of other hospitals should be billing and collecting payment from the other inpatient hospitals and not from Medicare....more

Bradley Arant Boult Cummings LLP

CMS Limits Required Participation in Comprehensive Care for Joint Replacement Model; Cancels Episode Payment Models

On August 15, 2017, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would significantly roll back two of CMS’s mandatory alternative payment models. The Proposed Rule would make continued...more

Cooley LLP

Blog: OIG Releases August Work Plan Items

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As we recently announced, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The August updates released this week include 4 new Work Plan items: - ...more

Akerman LLP - Health Law Rx

The AHA’s Letter to Santa Claus

The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717...more

Foley & Lardner LLP

Hospital Short-Stay Review Ban Lifted by CMS

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Effective September 12, 2016, the Centers for Medicare & Medicaid Services (CMS) lifted the temporary ban on patient status reviews of hospital short stays for Medicare beneficiaries. Those reviews are currently conducted by...more

Baker Donelson

The MOON Notification is Coming: CMS Publishes Final Changes

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CMS is moving forward with implementing the Medicare Outpatient Observation Notice (MOON) as announced in its FY 2017 IPPS Final Rule [PDF] on August 2, 2016, and published in the Federal Register on August 22, 2016 (Final...more

King & Spalding

CMS Proposes New Bundled Payment Models for Cardiac and Orthopedic Care

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On July 25, 2016, CMS posted a proposed rule that would create three new Medicare Parts A and B episode payment models for patients admitted for care for a heart attack, bypass surgery or surgical hip/femur fracture treatment...more

Polsinelli

Coming Soon to a Hospital near You: Mandatory Bundled Payments for Common Surgeries

Polsinelli on

Recent action by the Centers for Medicare and Medicaid Services (CMS) announces significant change in reimbursement methodology for high volume orthopedic surgical procedures in many markets nationwide. Affected stakeholders...more

Arnall Golden Gregory LLP

Expansion of Medicare Bundled Payment for Care Improvement Initiative

On August 13, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that 2,115 providers are participating in Phase 2 of the Medicare Bundled Payment for Care Improvement initiative (BPCI). These providers...more

BakerHostetler

Kane and the “60-Day Rule”: The Unforgiving World of Medicare and Medicaid Overpayments

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The Southern District of New York has spoken on one of the first issues to confront those seeking compliance with the new “60-day rule” under the Affordable Care Act (ACA), and it does not bode well for defendant hospitals...more

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Morgan Lewis

Sixty Days of Gray: Medicare and Medicaid Refund Requirements - Hospital Industry Viewpoint

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Although CMS has not yet issued a final rule on the ACA’s 60-day repayment provisions, hospitals and other providers can still create policies and train staff in a manner that gives them some measure of protection. Even with...more

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