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CMS Announces New Conditions of Participation for Long-Term Care Facilities

Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.

LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three. Read More ›

Categories: Compliance, Long Term Care, Medicare/Medicaid, News & Events, Pharmacy, Providers

DOJ Starts Cracking Down on Individual Health Care Executives for False Claims Act and Stark Law Violations Committed by Their Companies

Healthcare executives and physicians take note: The Department of Justice is now cracking down on individuals, and not just companies, for False Claims Act, Stark law, and anti-kickback statute violations. Read More ›

Categories: Hospitals, Medicare/Medicaid, News & Events, Physicians

CMS Final Rule on Reporting and Returning of Overpayments Has Potentially Only an Eight-Month Safe Harbor

The Final Rule on Reporting and Returning of Overpayments (“Final Rule”), which became effective on March 14, 2016, requires Medicare providers to report and return Medicare overpayments by the later of (i) 60 days after the date on which the overpayment was identified, or (ii) the date on which any corresponding cost report was due. This 60-day deadline for returning overpayments is suspended when any of the following occurs: Read More ›

Categories: Billing/Payment, Compliance, Medicare/Medicaid

Quality versus Quantity Transformation in Healthcare Picks Up Pace as CMS Issues New Rules

The march to transform Medicare from a quantity-based to a value-based system continues unabated - and the pace is quickening. Over the past several months, the Centers for Medicare & Medicaid Services (“CMS”) issued several final rules to update certain Medicare reimbursement rates and quality reporting requirements that impact vast numbers of healthcare providers. Read More ›

Categories: Billing/Payment, Medicare/Medicaid, Providers

Nursing Homes Should Review Privacy Policies in Light of Recent CMS Guidance

A recent Memorandum issued by the Centers for Medicare & Medicaid Services ("CMS") to state survey agency directors (the "Memorandum") discusses a nursing home's responsibility to protect residents' privacy, particularly with regard to social media. The Memorandum was issued following a series of media reports documenting the inappropriate posting of residents' photographs on social media by nursing home staff.  Read More ›

Categories: HIPAA, Medicare/Medicaid, Privacy

Data Breaches Lead to Record-Breaking HIPAA Settlement

HIPAAAdvocate Health Care Network (Advocate), one of the nation’s largest health care systems, recently reached a $5.55 million settlement with the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act (HIPAA). The $5.55 million settlement is the largest HIPAA settlement in history against a single entity.

OCR's investigation arose after Advocate reported three separate data breaches to OCR that occurred between July and November of 2013. The first breach occurred when four desktop computers were stolen from an Advocate administrative building. Another breach occurred when an unencrypted laptop was stolen from an Advocate employee's unlocked vehicle. A third breach occurred when an unauthorized third party accessed the network of a company that provides billing services to Advocate. A total of more than 4 million patient records were affected by the breaches.  Read More ›

Categories: Audits, Compliance, HIPAA, News & Events

CMS Expands Temporary Home Health Agency Enrollment Moratorium to all of Michigan

The Centers for Medicare & Medicaid Services ("CMS") recently announced the statewide expansion of its temporary moratorium on the Medicare enrollment of new home health agencies ("HHAs"), subunits, and branch locations in Michigan.  As a result of the moratorium expansion, effective as of July 29, 2016, new HHAs in Michigan are precluded from enrolling in Medicare until the moratorium is lifted. The temporary moratorium also precludes the Medicare enrollment of new HHAs in Florida, Illinois, and Texas.   Read More ›

Categories: Medicare/Medicaid, Providers

CMS Issues Proposed Provider-Based Status Rules

On July 6, 2016, the Centers for Medicare & Medicaid Services ("CMS") released the 2017 Outpatient Prospective Payment System ("OPPS") Proposed Rule (the "Proposed Rule"). The Proposed Rule explains how CMS plans to implement Section 603 of the Bipartisan Budget Act of 2015 ("Section 603"), which established a new site neutral payment policy for certain off-campus hospital outpatient departments.

Section 603 provides that, as of January 1, 2017, certain items and services provided by off-campus hospital outpatient departments will no longer be reimbursed under the more favorable OPPS, and will instead be paid under another "applicable payment system." Read More ›

Categories: Billing/Payment, Medicare/Medicaid, News & Events, Physicians, Providers

Michigan’s Health Insurance Claims Assessment Act is Upheld Once Again

Court Michigan’s tax on paid health care claims is not preempted by ERISA, according to a decision by the United States Court of Appeals for the Sixth Circuit. On remand from the United States Supreme Court, the federal appellate court held that the Health Insurance Claims Assessment Act does not impermissibly interfere with the uniform administration of group health plans or impose additional burdens on self-insured plans and third-party administrators. Read More ›

Categories: 6th Circuit Court of Appeals, Insurance, News & Events, Tax

OCR Begins Phase 2 Audit Program of Covered Entities and Business Associates

AuditThe U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it has begun Phase 2 of its HIPAA audit program. This audit phase will impact covered entities and their business associates. Read More ›

Categories: Compliance, HIPAA, Hospitals, Providers