Articles and Blogs


CMS Announces “BPCI Advanced”


Posted on January 10, 2018 in Health Law News

Published by: Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) announced its long-awaited “BPCI Advanced” model on January 9. The model – which is voluntary – will initially include 29 inpatient clinical episodes and 3 outpatient clinical episodes (a list of the 32 clinical episodes can be found here). BPCI Advanced Participants must elect to be... READ MORE

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CMS Proposes Format Changes for Plans of Correction and Allegations of Compliance


Posted on June 28, 2017 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

On June 16, 2017, CMS issued transmittal S&C: 17-34-ALL. This transmittal set forth changes to the format of Plans of Correction (“POC”) and Allegations of Compliance (“AOC”). Providers will no longer be required to write their POC/AOC on the right side of the CMS Form 2567 (“2567”). Providers are now allowed to submit the... READ MORE

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


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


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 DHS 124, described in the governor’s 2013 Regulatory Review Report as “outdated, duplicative, and confusing for health care operators,” has been the focus of regulatory reform efforts for more than a decade.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


The Medicare Chess Game: New Moves for Some Urban Hospitals


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


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


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


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


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


House Budget Bill Targets New Off-Campus Hospital Departments


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


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


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


CMS proposes new “incident to” rule


Posted on July 10, 2015 in False Claims Act Defense

Written by: David B. Honig

“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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