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cms

Key Takeaways from 2020 Hospital Outpatient Prospective Payment System Final Rule

[11/08/19]

Posted on November 8, 2019 in Health Law News

Published by: Hall Render

On November 1, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule for the Calendar Year (“CY”) 2020 Hospital Outpatient Prospective Payment System (“Final Rule”). Among many other changes, CMS finalized three key payment policy updates impacting hospital outpatient departments, including: (1) reducing payments for clinic visits at off-campus provider-based departments (“PBDs”);... READ MORE

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Next Up for Patient Driven Payment Model? Key Legal and Compliance Considerations Ahead for PDPM

[10/08/19]

Posted on October 8, 2019 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

With the October 1, 2019 beginning date now past for Patient Driven Payment Model (“PDPM”), the new skilled nursing case-mix classification mode under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for classifying SNF patients in a covered Medicare Part A stay, providers need to consider several key legal and compliance program considerations... READ MORE

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Countdown to Phase 3 – Skilled Nursing Infection Preventionist

[10/02/19]

Posted on October 2, 2019 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

Beginning on November 28, 2019, surveyors will use the requirements detailed in 42 C.F.R. Section 483.80 of the Code of Federal Regulations Requirements for States and Long-Term Care Facilities (“Final Regulations”) to determine whether a skilled nursing facility (“Facility”) has an infection preventionist on staff who is a primary professional trained in nursing, medical... READ MORE

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Hospitals Win Battle Over Site-Neutral Pay Cuts

[09/18/19]

Posted on September 18, 2019 in Health Law News

Published by: Hall Render

CMS was dealt a blow from the D.C. District Court on September 17, 2019 when the court determined the agency’s “site neutral” payment policy in the CY 2019 Outpatient Prospective Payment System (“OPPS”) Final Rule exceeded its statutory authority to adjust payments under the OPPS. Refusing to accept the government’s argument that the plaintiffs... READ MORE

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CMS’s Reach May Be Limited in Bankruptcy Proceedings

[09/17/19]

Posted on September 17, 2019 in Health Law News

Published by: Hall Render

The Bankruptcy Court for the District of Delaware analyzed whether CMS could suspend payments to a health care organization once the organization seeks bankruptcy court protection. The question centered on whether such payments are considered estate property within the scope of the automatic stay rule, 11 U.S.C. § 362. This case highlights the limits... READ MORE

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Here’s Price Transparency![1]

[09/13/19]

Posted on September 13, 2019 in Health Law News

Published by: Hall Render

On June 24, 2019, the Trump administration changed the game for the health care industry through the release of an executive order on price transparency. Entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” the executive order is aimed primarily at giving patients access to price and quality information about... READ MORE

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CMS Finalizes New Anti-Fraud Tools Aimed at Affiliations

[09/10/19]

Posted on September 10, 2019 in Health Law News

Published by: Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) could revoke or deny a provider’s or supplier’s Medicare enrollment if it determines that any of its affiliations pose an “undue risk” under a Final Rule announced on September 5, 2019 (“Enrollment Rule”). Also under the Enrollment Rule, providers and suppliers (“Providers”) selected by CMS will... READ MORE

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MIPS Targeted Review Request Deadline September 30

[09/05/19]

Posted on September 5, 2019 in Health Law News

Published by: Hall Render

CMS recently posted reminders regarding the availability of MIPS final scores and the deadline to request review if an error has been made: “If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are available for review on the Quality... READ MORE

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Reminder: Many Hospitals Will Be Required to Report Lab Price Data as Part of PAMA Changes

[09/03/19]

Posted on September 3, 2019 in Health Law News

Published by: Hall Render

In 2014, Congress enacted the Protecting Access to Medicare Act (“PAMA”), changing the landscape of Medicare reimbursement for lab services. PAMA required the Centers for Medicare & Medicaid Services (“CMS”) to establish a single, national Clinical Laboratory Fee Schedule (“CLFS”) based on current charges in the private health care market. Below, we provide background... READ MORE

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Skilled Nursing Arbitration Agreements Are Back with Restrictions – CMS Issues Final Regulations on Skilled Nursing Arbitration Agreements

[08/14/19]

Posted on August 14, 2019 in Long-Term Care, Home Health & Hospice

Published by: Hall Render

On July 18, 2019, the Centers for Medicare & Medicaid Services (“CMS”) published final regulations titled “Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements” (“Final Regulations”) to Part 483 to Title 42 of the Code of Federal Regulations the Requirements for States and Long-Term Care Facilities. The Final Regulations... READ MORE

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