Showing 67 posts by Julie LaVille Hamlet.
CMS Issues Final Rule on Reporting and Returning Overpayments
On February 11, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued its long-awaited Final Rule on Reporting and Returning of Overpayments (the “Final Rule”). The Final Rule, which will become effective on March 14, 2016, implements section 1128J(d) of the Affordable Care Act (“ACA”). This Section of the ACA requires that Medicare providers report and return Medicare overpayments by the later of (A) the date that is 60 days after the date on which the overpayment was identified; or (B) the date any corresponding cost report is due, if applicable (the “60-day rule”). According to CMS, the purpose of the Final Rule is to provide “needed clarity and consistency in the reporting and returning of self-identified overpayments.”
CMS issued a Proposed Rule on Reporting and Returning of Overpayments (the “Proposed Rule”) on February 16, 2012. The Final Rule includes some important changes to the provisions of the Proposed Rule. A summary of the major provisions of the Final Rule appears below. Read More ›
Categories: Billing/Payment, Health Care Reform, Medicare/Medicaid, News & Events
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OCR Issues Clarifying Guidance on HIPAA Privacy Rule Regarding Access to Protected Health Information
The Office of Civil Rights (“OCR”) recently issued new guidance (“Guidance”) concerning the right of individuals to access their protected health information (“PHI”) under the HIPAA Privacy Rule. The OCR explained in the Guidance that based on its enforcement experience and recent studies, individuals continue to have difficulty accessing information - even from entities required to comply with the HIPAA Privacy Rule. This is also despite improvements in technology that make access more readily available. Bottom line is that individuals must have access to their PHI and health providers need to be providing such access.
However, the Guidance further clarifies a number of issues, including permissible charges for providing information to patients, security issues, submission of requests for information, and the manner for providing access to information. Read More ›
Categories: HIPAA, News & Events, Privacy
CMS Releases Draft Plan to Support Transition to Value-Based Payment System
As part of the continuing transition toward a physician payment system based more on quality than quantity, the Centers for Medicare & Medicaid Services (“CMS”) recently released a draft Quality Measure Development Plan (the “Plan”). The Plan is authorized by the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), which mandated that CMS post a draft plan for the development of quality measures by January 1, 2016. The Plan explains how CMS will support the transition to the new Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”). Read More ›
Categories: Medicare/Medicaid
CMS Issues Final Home Health Payment Rules for 2016
On October 29, 2015, the Centers for Medicare & Medicaid Services (CMS) issued the final home health prospective payment system (PPS) rule for calendar year (CY) 2016. CMS projects that the impact of the final rule will result in a 1.4 percent (or $260 million) reduction in Medicare payments to home health agencies (HHAs) from 2015 payment levels. Read More ›
Categories: Billing/Payment, Medicare/Medicaid
DOJ Memo: Corporate Investigations to Focus on Individual Accountability
Recent guidance issued by the U.S. Department of Justice (“DOJ”) reveals the government’s renewed focus on individual accountability during corporate investigations. On September 9, 2015, Deputy U.S. Attorney General Sally Quillian Yates issued a memorandum to DOJ attorneys (the “Yates Memo”) that emphasizes the importance of seeking accountability from the individuals who are responsible for corporate wrongdoing.
The Yates Memo outlines six measures that should be taken by federal prosecutors during any investigation of corporate misconduct in order to hold accountable the individuals who are responsible for the conduct. A discussion of each measure appears below. Read More ›
Categories: Fraud & Abuse, Providers
CMS Issues Final Rules for Fiscal Year 2016 Provider Payments
On July 31, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued final Medicare payment rules for federal fiscal year 2016 (the “Rules”). The Rules affect hospitals, hospices, psychiatric facilities, and rehabilitation facilities. Read More ›
Categories: Billing/Payment, Medicare/Medicaid, News & Events, Providers
HHS Issues HIPAA “Basics” Fact Sheet
The Department of Health and Human Services (“HHS”) recently released a HIPAA overview called “HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules” (the “Overview”). The Overview is intended to provide HIPAA Covered Entities such as physicians, hospitals, and other health care providers with a basic overview of HIPAA’s rules and responsibilities. The fact sheet also provides an overview to Business Associates (such as law firms and accounting firms who receive protected health information ("PHI") from Covered Entities). The Overview can be found here.
The Overview explains that the HIPAA Privacy Rule protects individually identifiable PHI, which includes information such as an individual’s past, present, or future physical or mental health condition. Read More ›
Categories: HIPAA, News & Events, Privacy, Providers
Health Insurance Rate Increases Approved for 2016
On Tuesday, August 18, the Michigan Department of Insurance and Financial Services (“DIFS”) announced that it has approved health insurance rate increases that average 6.5 percent for the individual market and 1 percent for the small group market.
Each year, DIFS is responsible for reviewing rate changes proposed by health insurers to determine whether such changes comply with state and federal laws. As part of its review this year, DIFS considered public comments that were submitted after the requested rate changes were posted. DIFS approved all rate changes as requested after determining that such changes were actuarially supported. Read More ›
Categories: Insurance, News & Events
Virginia Man Wins $500,000 After Recording Surgical Team’s Insulting Comments
Talk about adding insult to injury. A Virginia man woke up after his colonoscopy to learn that the surgical team had mocked, belittled and insulted him throughout the procedure.
Fearful that he would not remember the doctor’s post-op instructions, the man pressed record on his smartphone before receiving anesthesia. Upon listening to the recording after the procedure, he realized that the members of the surgical team began their rant as soon as he drifted off to sleep. Read More ›
Categories: Hospitals, News & Events, Physicians
Health Care Trends
Rural hospitals across the United States struggling to stay open
According to the National Rural Health Association, approximately 50 hospitals in the rural United States have closed since 2010. The number of annual closures is growing. Congressional healthcare budget cuts and policy changes significantly affect rural hospitals because rural hospitals often have a disproportionate number of patients who are covered under Medicare, Medicaid or who are uninsured. A number of factors affect and pose challenges to rural hospitals. One challenge is the difficulty of attracting talent, which often means paying more to healthcare professionals in order to recruit them for employment at a rural hospital. Other challenges facing rural hospitals include:
- changing demographics;
- advances in medical practice that the hospital may be unable to implement;
- new federal regulations and standards that create additional compliance related pressure; and
- lower reimbursement rates for Medicare and Medicaid.
Closures of rural hospitals may force individuals to travel long distances for medical care, which may lead to an increase in mortality rates. The closures may discourage business ventures in rural areas due to the increased costs associated with not having a healthcare facility nearby. Metropolitan hospital closings have increased recently, but the existence of medical care alternatives in metropolitan areas typically reduces the effects that closures have on patients. Read More ›
Categories: Health Care Reform, Hospitals, Insurance, News & Events, Physicians, Tax
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.