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Medicaid › Medicare Part A › Medicare Part B

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
Foley & Lardner LLP

Medicare Overpayments: CMS Proposes Regulation Establishing Six Month Suspended Deadline for 60-Day Refund Rule

Foley & Lardner LLP on

The 60-day Refund Rule, created by the 2010 Affordable Care Act, requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. See Section 1128J(d) of the Social Security Act,...more

McDermott+

President Biden Releases FY 2025 Budget: What’s NOT in It?

McDermott+ on

Earlier this week, President Biden released his Fiscal Year (FY) 2025 President’s Budget. As a reminder, every year, the White House releases a budget that serves as its official funding request to Congress for the following...more

King & Spalding

CMS Proposes Changes to the Medicare Advantage and Part D Programs Aimed at Improving Beneficiary Protections, Access to Care, and...

King & Spalding on

On November 6, 2023, CMS released a pre-publication version of a proposed rule (Proposed Rule) that is set to publish in the Federal Register on November 15, 2023, and that would amend the regulations governing Medicare...more

Holland & Knight LLP

Holland & Knight Health Dose: October 4, 2022

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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. This week's topics include... ...more

Ruder Ware

CMS Releases Key Medicare Figures for 2022

Ruder Ware on

The Centers for Medicare and Medicaid Services (“CMS”) recently released key Medicare figures for 2022 that will affect all elderly and disabled individuals who receive program benefits.  This notice summarizes the changes...more

Mintz - Health Care Viewpoints

Telehealth Update:  New Bill Seeks to Understand the Impact of Telehealth During COVID-19 as State COVID-19 Orders Expire

Mintz - Health Care Viewpoints on

As previously discussed, many of the telehealth flexibilities in place during the COVID-19 pandemic are set to expire at the end of the federal Public Health Emergency (PHE), unless federal and state legislators act to make...more

Foley & Lardner LLP

COVID-19 Compounds Opioid Crisis and Treatment Gaps for Vulnerable Americans: Will a Biden Administration and New Congress Expand...

Foley & Lardner LLP on

Payment misalignment in Medicare FFS for Substance Use Disorder (SUD) treatment as the subject of potential legislative and/or regulatory reforms - New opportunities for investor-backed behavioral health platforms in...more

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

Understanding Medicare

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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

King & Spalding

HHS Publishes General and Targeted Distribution Post-Payment Notice of Reporting Requirements

King & Spalding on

Under the Provider Relief Fund Terms and Conditions, each recipient is required to submit reports to HHS. This notice supplements HHS’ July 20, 2020 Post-Payment Notice of Reporting Requirements (previously reported on here)....more

King & Spalding

CMS Proposes to Codify the Definition of “Reasonable and Necessary” and to Establish a New Medicare Coverage Pathway

King & Spalding on

On September 1, 2020, CMS published a proposed rule that would define “reasonable and necessary” for purposes of coverage under Part A and Part B of the Medicare program, and that would establish a new expedited Medicare...more

Chambliss, Bahner & Stophel, P.C.

Can You Transfer Your Medicare and Medicaid Plans When You Move to Another State?

Chambliss, Bahner & Stophel, P.C. on

If you plan to move states, can you take your Medicare or Medicaid plans with you? The answer depends on whether you have original Medicare, Medicare Advantage, or Medicaid. Medicare - If you have original Medicare...more

Greenbaum, Rowe, Smith & Davis LLP

COVID-19 And Medicare Alternate Payment Programs

Greenbaum, Rowe, Smith & Davis LLP on

Insurance payments for healthcare services and supplies are frequently based on projections of future costs, often measured against a baseline calculated on past costs. However, COVID-19 and its attendant changes to the...more

Sheppard Mullin Richter & Hampton LLP

Blog Series Part 5: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug...

Sheppard Mullin Richter & Hampton LLP on

Part D Plan Sponsors’ Access to Medicare Parts A and B Claims Data Extracts - As detailed in previous posts in this series, one major objective that the Centers for Medicare and Medicaid Services (“CMS”) addressed in a...more

Alston & Bird

New Initiatives for the New Year: Highlights of the OIG’s 2017 Work Plan

Alston & Bird on

On November 10, 2016, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its 2017 Work Plan. The 2017 Work Plan outlines the areas of special concern to the OIG and...more

Sheppard Mullin Richter & Hampton LLP

The Overpayment Rule and the Implied False Claims Theory: “What You Don’t Know Can Still Hurt You”

Sheppard Mullin Richter & Hampton LLP on

In 2010, the Affordable Care Act (“ACA”) enacted new rules governing overpayments made by the Medicare and Medicaid programs. Under these rules, providers have 60 days from the date that the overpayment has been identified to...more

Hinshaw & Culbertson LLP

OIG Mid-Year Updated Provides Insight To Its Concerns

Hinshaw & Culbertson LLP on

The Office of Inspector General (OIG) recently released its mid-year update of its Fiscal Year Work Plan for 2016. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue. Not...more

Baker Donelson

CMS Takes First Step to Reduce Payments for Clinical Laboratory Tests

Baker Donelson on

CMS recently published a proposed rule that would substantially revise the methodology used to pay for clinical laboratory tests that continue to be compensated separately by Medicare. Medicare Program; Medicare Clinical...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

Robinson & Cole LLP

Federal Court Rejects Health System's Efforts to Dismiss 60-Day Rule Suit

Robinson & Cole LLP on

On August 3, 2015, the United States District Court in the Southern District of New York issued a long-awaited opinion and order rejecting a motion to dismiss filed by the defendants in U.S. ex rel. Kane v. Continuum Health...more

BakerHostetler

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

BakerHostetler on

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

Mintz - Health Care Viewpoints on

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

Morgan Lewis on

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

Mintz - Health Care Viewpoints

GAO Report Highlights Improper Medicare/Medicaid Payments

Mintz - Health Care Viewpoints on

Despite the efforts of the Department of Health and Human Services (HHS) to combat fraud and contain costs in federal healthcare programs, Medicare’s fee-for-service program (Parts A and B) and Medicaid were two of the top...more

Cooley LLP

Blog: HHS OIG Hands Out 2015 Work Plan For Halloween

Cooley LLP on

On Friday October 31, 2014, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) released its annual “Work Plan” for fiscal year 2015. The Work Plan is a compilation of the OIG’s plans for...more

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