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CMS Proposes Major Change to Medicare Part B Drug Payment System Introducing International Pricing Index Model

[11/09/18]

Posted on November 9, 2018 in Health Law News

Published by: Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) Center for Medicare and Medicaid Innovation proposed to lower the cost of Medicare Part B outpatient prescription drugs by establishing their prices based on lower drug prices of other advanced industrial nations as compiled in an “international price index” (“IPI”) and changing the way the current drug... READ MORE

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CMS Letter to Clinicians – E/M Documentation Update

[11/09/18]

Posted on November 9, 2018 in Health Law News

Published by: Hall Render

On November 8, 2018, CMS released a letter to clinicians regarding E/M documentation and coding reform. This follows the CY 2019 Medicare Physician Fee Schedule Final Rule intentions to reduce burden on clinicians in furtherance of the agency’s “Patients Over Paperwork” initiative. Effective January 1, 2019, CMS will: Simplify the documentation of history and exam... READ MORE

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CMS Proposes to Simplify Coding and Documentation Requirements for E/M Services but with a Catch

[09/28/18]

Posted on September 28, 2018 in Health Law News

Published by: Hall Render

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“Proposed Rule”). Among many other changes, CMS proposed numerous modifications to the required documentation for evaluation and management (“E/M”) visits in order to alleviate the administrative burden on practitioners and... READ MORE

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CMS Allows Medicare Advantage Plans to Implement Step Therapy for Part B Drugs – Will It Really Lower Drug Costs or Simply Increase Administrative Burdens?

[09/19/18]

Posted on September 19, 2018 in Health Law News

Published by: Hall Render

On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE

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CMS Issues Final Interpretive Guidelines for the Conditions of Participation for Home Health Agencies

[09/06/18]

Posted on September 6, 2018 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

On January 13, 2017, CMS published the revised Conditions of Participation (“CoPs”) for home health agencies, 42 CFR 484, Subparts A, B, and Subpart C. The CoPs became effective on January 13, 2018. On August 31, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum to State Survey Agency Directors (QSO-18-25-HHA) that... READ MORE

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CMS Adds Survey Process for Reviewing Home Dialysis Services in Long-Term Care Facilities

[08/28/18]

Posted on August 28, 2018 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

On August 17, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum to State Survey Agency Directors (QSO-18-24-ESRD) outlining additional survey activities that address dialysis services provided by an end-stage renal disease (“ESRD”) facility to residents in a long-term care facility. The survey process for evaluating home dialysis in nursing homes consists... READ MORE

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CMS Issues Final Rule on FY 2019 Payment and Policy Changes for Skilled Nursing Facilities

[08/07/18]

Posted on August 7, 2018 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

On July 31, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (CMS-1696-F) outlining Fiscal Year (“FY”) 2019 Medicare payment updates and quality program changes for skilled nursing facilities (“SNF”)(“Final Rule”). The Final Rule finalized the value-based purchasing payments that start October 1, 2018, updated several SNF Quality Reporting Program... READ MORE

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Hall Render’s This Week in Washington – CMS Issues Hospital Inpatient Prospective Payment System Final Rule

[08/03/18]

Posted on August 3, 2018 in Federal Advocacy

Published by: Hall Render

This Week in Washington joined the House on its August break but has provided a news update to address CMS finalizing its Hospital Inpatient Prospective Payment System final rule. On August 2, CMS finalized its Hospital Inpatient Prospective Payment System final rule for fiscal year (“FY”) 2019. The final rule updates Medicare payment policies... READ MORE

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CMS Proposes Several Changes for Off-Campus Provider-Based Clinics

[08/03/18]

Posted on August 3, 2018 in Health Law News

Published by: Hall Render

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“MPFS Proposed Rule”). Among many other changes, CMS proposed to maintain payments for certain non-excepted (non-grandfathered) off-campus provider-based hospital departments (“PBDs”) at 40 percent of the Outpatient Prospective Payment System... READ MORE

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CMS Updates Requirements to Reduce Legionella Risk in Health Care Facility Water Systems and Identifies Surveyor Expectations – Review of Policies and Procedures Required

[07/12/18]

Posted on July 12, 2018 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

On July 6, 2018, the Survey and Certification Group at the Centers for Medicare & Medicaid Services (“CMS”) revised its memorandum, “Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease (LD)” (“S&C Memo”), that requires that facilities develop and follow policies and procedures that inhibit... READ MORE

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