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Medicare

CMS Finalizes New Conditions of Participation for Home Health: Part 1

[01/17/17]

Posted on January 17, 2017 in Health Law News, Long-Term Care, Home Health & Hospice

Published by: Hall Render

Review of the New Quality Assessment and Performance Improvement Condition This is the first article in a series discussing CMS’s pre-publication copy of the Final Revised Home Health Conditions of Participation (“Final CoPs”). With the release of the Final CoPs, CMS is finalizing, with only a few changes, the significant changes they proposed to... READ MORE

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Wisconsin Hospital Regulations Reformed: July 1, 2016

[06/23/16]

Posted on June 23, 2016 in Health Law News

Published by: Hall Render

Wisconsin’s long-standing hospital regulation, DHS 124, will be significantly reformed beginning on July 1, 2016. DHS 124, described in the governor’s 2013 Regulatory Review Report as “outdated, duplicative, and confusing for health care operators,” has been the focus of regulatory reform efforts for more than a decade. Signed into law on April 8, 2014,... READ MORE

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The Medicare Chess Game: New Moves for Some Urban Hospitals

[04/27/16]

Posted on April 27, 2016 in Health Law News

Published by: Hall Render

In an interim final rule published in the Federal Register on April 21 (“Rule”), the Centers for Medicare & Medicaid Services (“CMS”) amended its regulations to allow PPS hospitals located in urban areas to obtain a “412.103” urban to rural reclassification and also be reclassified for wage index purposes by the Medicare Geographic Classification... READ MORE

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Medicare Part D Fraud and Specialty Drugs Highlighted in OIG’s 2016 Work Plan

[12/09/15]

Posted on December 9, 2015 in Health Law News

Published by: Hall Render

Executive Summary Recently, the Department of Health and Human Services Office of Inspector General (“OIG”) released its Work Plan for Fiscal Year 2016 (“Plan”).  The Plan provides insight into OIG’s potential audit and enforcement activities for the next fiscal year.  While the Plan addresses several different provider types, this article addresses the Plan’s initiatives... READ MORE

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Budget Blast: Exclusion of Hospital Payment for “New” Off-Campus Hospital Departments

[11/03/15]

Posted on November 3, 2015 in Health Law News

Published by: Hall Render

Last week, Congress passed the Bipartisan Budget Act of 2015 (“Budget”), and President Obama signed the Budget into law on November 2, 2015.  Among many other changes, the Budget includes an impending exclusion on hospital coverage for off-campus hospital outpatient departments that first bill for services on or after November 2, 2015.  Even though site-neutral payment... READ MORE

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House Budget Bill Targets New Off-Campus Hospital Departments

[10/29/15]

Posted on October 29, 2015 in Health Law News

Published by: Hall Render

Yesterday, the House passed a sweeping budget bill that impacts Medicare coverage of services provided in off-campus hospital departments.  Currently, Medicare pays for items and services provided in both on- and off-campus hospital outpatient departments as hospital services when those departments are in compliance with 42 CFR §413.65 (the Medicare “provider-based rule”).  With some... READ MORE

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NOTICE Act Requires Hospitals to Promptly Notify Medicare Patients of Observation Status

[08/04/15]

Posted on August 4, 2015 in Health Law News

Published by: Hall Render

On July 27, the Senate unanimously approved the Notice of Observation Treatment and Implication for Care Eligibility (“NOTICE”) Act, which was earlier approved unanimously by the House of Representatives in March. The bipartisan legislation will proceed to the President and is expected to be signed into law. The NOTICE Act makes changes to hospital... READ MORE

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CMS proposes new “incident to” rule

[07/10/15]

Posted on July 10, 2015 in False Claims Act Defense

Written by:

“Incident to” billing is a significant False Claims Act risk for Medicare and Medicaid providers. A new proposed rule will change how physicians and physician practices are supposed to bill for services provided in their offices. CMS Proposal to Limit Incident to Billing This week CMS released the proposed Medicare Physician Fee Schedule Rule... READ MORE

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Materiality and Government Knowledge in the Sixth Circuit

[02/03/15]

Posted on February 3, 2015 in False Claims Act Defense

Written by:

Written by David B. Honig and Steven H. Pratt. On February 2, the Sixth Circuit Court of Appeals ruled on a case from the Southern District of Ohio, US ex rel American Systems Consulting, Inc. v Mantech Advanced Systems International. At issue was whether a court may determine whether a knowingly false statement in a proposal for... READ MORE

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Extension of Due Date for Nursing Home Automatic Sprinkler Installation

[05/22/14]

Posted on May 22, 2014 in Long-Term Care, Home Health & Hospice

Written by:

On May 16, 2014, CMS issued a Survey and Certification Transmittal (“Transmittal”) to the state survey agency directors providing infomation on how Medicare and Medicaid certifed long-term care facilities may obtain an extension of time for the installation of automatic sprinkler sytems.  The Transmittal sets forth the procedures on how a nursing home may seek an... READ MORE

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