Articles and Blogs

Medicare

Can Individuals and Hospitals Sue Wrongdoers Under the Medicare Secondary Payer Act?

[09/17/19]

Posted on September 17, 2019 in Health Law News

Published by: Hall Render

In a recent Sixth Circuit decision,[1] the Court concluded that an individual Medicare beneficiary, who had successfully sued a tortfeasor for personal injuries he suffered, did not have the right to bring a cause of action under the Medicare Secondary Payer Act (“MSPA”).[2] In effect, the Court concluded that the MSPA did not provide rights... 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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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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CMS Finalizes Changes for Low Wage Hospitals and Rural Floor

[08/19/19]

Posted on August 19, 2019 in Health Law News

Published by: Hall Render

On August 16, 2019, the Federal Fiscal Year (“FFY”) 2020 Medicare Inpatient Prospective Payment System (“IPPS”) final rule (“IPPS Final Rule”) was published in the Federal Register. In the IPPS Final Rule, the Centers for Medicare & Medicaid Services (“CMS”) finalized several changes announced in the proposed rule, including several changes to address disparities between high... READ MORE

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Hall Render’s This Week in Washington – June 28, 2019

[06/28/19]

Posted on June 28, 2019 in Federal Advocacy

Published by: Hall Render

Senate Committee Advances Major Health Legislative Package The Senate Health, Education, Labor, and Pensions (“HELP”) Committee passed a wide-ranging bill focusing on lowering health care costs to the chamber’s floor. This legislation is one of the only major health care bills that stands a chance at passing Congress this year. The measure aims to... READ MORE

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Medicare Hospital Co-Location Fix? Not There Yet…

[05/07/19]

Posted on May 7, 2019 in Health Law News

Published by: Hall Render

On May 3, 2019, CMS released its long-awaited guidance on hospital co-location and shared service arrangements in the form of a draft survey memo (“Memo”), which is available here. The Memo clarifies how a hospital can co-locate with other health care entities without violating the Medicare Conditions of Participation (“CoPs”). CMS has been promising... READ MORE

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Medicare Paid Twice for Ambulance Services Subject to SNF Consolidated Billing

[04/19/19]

Posted on April 19, 2019 in Health Law News

Published by: Hall Render

Summary In a February 2019 report, No. A-01-17-00506, HHS Office of the Inspector General (“OIG”) determined that Medicare made Part B payments to ambulance suppliers for transportation services that were covered through the Medicare Part A payments to skilled nursing facilities (“SNF”) as part of consolidated billing requirements. With certain exceptions, the SNF Part... READ MORE

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ET3 Phone 911: Developments in Ambulance Services Delivery and Payment

[04/15/19]

Posted on April 15, 2019 in Health Law News

Published by: Hall Render

Summary On February 14, 2019, the U.S. Department of Health and Human Services (“HHS”) Center for Medicare and Medicaid Innovation (“CMMI”) launched a new five-year payment model for emergency ambulance services named the Emergency Triage, Treat and Transport Model (“ET3”). ET3 will enable participating ambulance providers and suppliers (“Ambulance Providers”) to partner with qualified... READ MORE

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Hall Render’s This Week in Washington – April 12, 2019

[04/12/19]

Posted on April 12, 2019 in Federal Advocacy

Published by: Hall Render

Congressional Leaders Discuss Health Care Priorities Congress’ top leaders, Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Nancy Pelosi (D-CA), announced they are not embracing “Medicare for All” as a priority at the American Hospital Association’s annual Washington conference. Both leaders reinforced that each chamber will pursue largely separate health care agendas in... READ MORE

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Hall Render’s This Week in Washington – March 29, 2019

[03/29/19]

Posted on March 29, 2019 in Federal Advocacy

Published by: Hall Render

Conversation Shifts Back to Health Care in Washington Health care became a major discussion point for lawmakers after this week started with the Trump administration’s declaration that it supports a federal judge’s ruling that the entire Affordable Care Act (“ACA”) should be thrown out. This signals a shift in the Justice Department’s prior position... READ MORE

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