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Payment Systems Health Care Providers Centers for Medicare & Medicaid Services (CMS)

Baker Donelson

Significant Changes Affecting Hospitals in CMS's FY 2025 IPPS Final Rule

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CMS published its FY 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule on August 1, 2024. Under this final rule, CMS is implementing several changes to its Hospital Inpatient Quality Reporting...more

McDermott+

CMS Releases FY 2025 Hospital Inpatient Prospective Payment System (IPPS) Final Update

McDermott+ on

On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) posted the Hospital Inpatient Prospective Payment System (IPPS) final update for fiscal year (FY) 2025, along with proposed policy and regulation changes....more

ArentFox Schiff

Post-Chevron Health Care Regulations: Using Loper Bright as a Shield in Stark Law Litigation

ArentFox Schiff on

Previously, we discussed how the US Supreme Court’s opinion in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce could create opportunities for private litigants to challenge health...more

King & Spalding

Physician Fee Schedule Proposed Rule Proposes New Quality-Driven Payment Policies

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Within its proposed CY 2025 Physician Fee Schedule (PFS) rule (the Proposed Rule), CMS is proposing to implement new payment policies intended to advance health equity and support whole-person care. CMS expects these new...more

Health Care Compliance Association (HCCA)

Compliance with Medicare’s updated 2024 split (or shared) visit policy

Split (or shared) visits—the current term used by the Center for Medicare & Medicaid Services (CMS)—allow non-physician practitioners (NPPs) and physicians who work for the same employer/entity to share patient visits on the...more

McDermott+

McDermottPlus Check-Up: April 17, 2024

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House Energy & Commerce Health Subcommittee Holds Hearing on Cybersecurity. During the hearing, there was bipartisan concern about UnitedHealth Group’s response to the Change Healthcare cyberattack and consensus around the...more

ArentFox Schiff

Health Care Providers Navigate Fallout of Major Cyberattack on Change Healthcare

ArentFox Schiff on

Change Healthcare, an affiliate of Optum and UnitedHealth Group, processes more than 15 billion health care transactions annually and touches one of every three patient records. On February 21, Change disconnected its...more

McDermott Will & Emery

Remote Monitoring and Digital Therapies: CMS Updates Coverage and Payment Policies

McDermott Will & Emery on

In recent years, the Centers for Medicare & Medicaid Services (CMS) has expanded payment for remote monitoring services in an effort to pay for non-face-to-face services that improve care coordination for Medicare...more

Robinson+Cole Health Law Diagnosis

CMS Announces 0.8 Percent Aggregate Home Health Payment Increase in 2024

On Wednesday, November 1, the Center for Medicare & Medicaid Services (CMS) released its Home Health Prospective Payment System Rate Update final rule for CY 2024 (the Final Rule). The Rule estimates that the aggregate...more

McDermott+

End-Stage Renal Disease Prospective Payment System CY 2024 Final Rule

McDermott+ on

On October 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Calendar Year (CY) 2024 final rule (CMS-1782-F). The rule finalizes minimal...more

Butler Snow LLP

Prior Authorization Reform in Healthcare: Winds of Change?

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Bob Dylan, winner of the Nobel Prize in Literature and one of the greatest American songwriters of all time, has effectively used wind as a metaphor in a number of songs he has written, each with its own distinct message....more

Foley Hoag LLP

CMS Proposes Updates to Medicare Dental Coverage Pathway

Foley Hoag LLP on

On July 13, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY2024 Physician Fee Schedule (PFS) proposed rule. This rule addresses changes in Medicare payment policies for physician services. Over the...more

McDermott+

McDermottPlus Check-Up: August 4, 2023

McDermott+ on

Congress is officially in recess for the month of August and will return after Labor Day. On the regulatory front, the Centers for Medicare & Medicaid Services (CMS) released the final fiscal year (FY) 2024 Inpatient...more

McDermott+

Policy Update - CMS Releases FY 2024 IPPS Final Rule

McDermott+ on

On August 1, 2023, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) final rule. The rule updates Medicare payment policies and quality reporting...more

McDermott+

Breaking Down the CY 2024 Hospital Outpatient Proposed Reg

McDermott+ on

As most of you already know, the Centers for Medicare & Medicaid Services (CMS) recently released two Medicare payment regulations: the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed reg and the CY 2024...more

Nelson Mullins Riley & Scarborough LLP

Payment Cuts and Program Changes: CMS Issues Calendar Year 2024 Home Health Prospective Payment System Proposed Rule

On June 30, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Home Health Prospective Payment System for the 2024 calendar year. The proposed rule aims to permanently update the payment...more

Sheppard Mullin Richter & Hampton LLP

CMS Releases Updates to Hospital Pricing Transparency Rule

On April 26, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released a fact sheet on Hospital Price Transparency Enforcement Updates (the “Fact Sheet”) under the Hospital Price Transparency Rule (the “Rule”)....more

Manatt, Phelps & Phillips, LLP

Executive Summary: Tracking Telehealth Changes State-by-State in Response to COVID-19 - April 2023

As the COVID-19 pandemic continues across the United States, states, payers, and providers are looking for ways to expand access to telehealth services. Telehealth is an essential tool in ensuring patients are able to access...more

McDermott Will & Emery

CMS Clarifies Coverage and Payment for Remote Therapeutic Monitoring Services

McDermott Will & Emery on

On November 1, 2022, the US Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2023 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS) (the Final Rule). The Final...more

Bradley Arant Boult Cummings LLP

CMS Changes Course: Increases Medicare Reimbursement Rates for 2023 Fiscal Year

On Friday, July 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued its 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule on 2023 Medicare rates for skilled nursing facilities...more

Sheppard Mullin Richter & Hampton LLP

California Passes First State Law Requiring Physicians to Disclose Open Payments Database to Patients

Effective January 1, 2023, the recently enacted California Assembly Bill 1278,requires a physician and surgeon (defined as a physician and surgeon licensed pursuant to the Medical Practice Act or an osteopathic physician and...more

Foley Hoag LLP - Medicaid and the Law

HHS Ordered to Correct Medicare Payments to 340B Hospitals for Remainder of 2022

We have noted before the link between the Medicaid prescription drug rebate program and the 340B program. As we wrote in an earlier Client Alert, in June 2022, the U.S. Supreme Court struck down HHS’s Medicare payment cuts to...more

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | August 2022 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant enforcement activity between July 21 and August 20, 2022. Key updates include a case in which the US Court of Appeals for the Eighth Circuit...more

King & Spalding

CMS Issues Guidance to Improve Care for Children with Medically Complex Conditions

King & Spalding on

On August 1, 2022, CMS issued guidance on the implementation of Section 1945A of the Social Security Act (the Act), which gives states the option to cover health home services for Medicaid-eligible children under age 21 with...more

McDermott Will & Emery

Healthcare Regulatory Check-up Newsletter | May 2022 Recap

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This issue of McDermott’s Healthcare Regulatory Check-Up highlights notable enforcement activity between April 21 and May 20, 2022, including a telemedicine case involving $64 million in false and fraudulent claims. We also...more

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