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Showing 42 posts in Providers.

CMS Releases 2018 Inpatient PPS Proposed Rule

Medicare and Medicaid ServicesOn April 14, 2017, the Centers for Medicare & Medicaid Services issued its 2018 Medicare Inpatient Prospective Payment System proposed rule (the “Proposed Rule”). The Proposed Rule was published in the Federal Register on April 28, 2017, and comments will be accepted through June 13, 2017.

The Proposed Rule suggests a number of changes that would affect hospital rates, inpatient quality reporting and readmissions reduction programs. Some of the most significant changes are highlighted below. Read More ›

Categories: Compliance, Medicare/Medicaid, Providers

Obamacare Repeal and Replacement Plan- What does it mean for Employers?

Legislation introduced to repeal portions of the Affordable Care ActLate in the afternoon on March 6, two committees of the U.S. House of Representatives introduced legislation that would replace and repeal significant portions of the Patient Protection and Affordable Care Act, also known as the ACA or Obamacare. The new legislation, titled the American Health Care Act, addresses a number of key complaints that have been raised by employers since the ACA's implementation. Several provisions of the new legislation that are of particular interest to employers are described briefly below. Read More ›

Categories: Employment, Health Care Reform, Providers

CMS Releases Final Rule Revising Conditions of Participation for Home Health Agencies

health care written informationOn January 9, 2017, the Centers for Medicare & Medicaid Services (“CMS”) issued final rules that establish minimum standards for home health agencies (the “Rules”). According to CMS, the Rules are intended to improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights.

The Rules, which were published in the Federal Register on January 13, 2017, come more than two years after a draft proposal was introduced in October 2014. The Rules are mostly adopted as proposed, with a few clarifying changes. The Rules will become effective on July 13, 2017. This means agencies have less than six months to make changes necessary to comply with the revisions. Read More ›

Categories: Medicare/Medicaid, News & Events, Providers

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

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

cms issues new rulesThe 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

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

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

HHS Issues Final Rule Implementing ACA Nondiscrimination Provisions

HHS Issues Final Rule Implementing ACA Nondiscrimination Provisions The U.S. Department of Health & Human Services ("HHS") recently issued a final rule that implements the nondiscrimination provisions under Section 1557 of the Affordable Care Act (the "Final Rule"). The Final Rule becomes effective July 18, 2016. Read More ›

Categories: Health Care Reform, News & Events, Providers

Sixth Circuit Affirms Dismissal of FCA Whistleblower Lawsuit Based on Health Data Breach

fca whistleblower lawsuitThe U.S. Court of Appeals for the Sixth Circuit recently affirmed a district court’s dismissal of a whistleblower lawsuit alleging violations of the False Claims Act based on an individual security breach. The case, United States ex rel. Sheldon v. Kettering Health Network, arose after the relator (or whistleblower) received letters from Kettering Health Network (KHN) informing her that KHN employees, including her now ex-husband, impermissibly accessed her medical records. Read More ›

Categories: 6th Circuit Court of Appeals, Compliance, HITECH Act, Providers