Even as long-term care providers celebrate a proposed 10-year moratorium on the nursing home staffing mandate[1], they are sounding the alarm over major Medicaid cuts included in the House-passed budget reconciliation bill...more
After a lengthy absence, the South Carolina Department of Health and Human Services (“SCDHHS”) announced on September 10, 2024, that its Medicaid Recovery Audit Contractor (“RAC”) program was resuming on October 1, 2024. ...more
On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published its controversial final rule imposing minimum staffing requirements for long term care facilities (the “Final Rule”). When it takes effect on June...more
On April 26, 2024, the Centers for Medicare and Medicaid Services (CMS) issued Questions and Answers concerning new hospice enrollment requirements for certifying physicians (CMS Q&As). In a nutshell, as of June 3, 2024, the...more
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued its controversial final rule related to the first federally imposed minimum staffing requirements for long term care facilities (“Final Rule”).[i] ...more
With Nursing Homes Still Struggling to Rebuild After the COVID-19 Pandemic, is This Advisable?
When The Centers for Medicare and Medicaid Services (CMS) posted the PPS and Consolidated Billing Updates for Skilled Nursing...more
For the first time, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can enroll as Medicare providers under provisions established in the Consolidated Appropriations Act of 2023. MFTs and MHCs can...more
Until recently, the idea of hospitals providing acute-care hospital services to patients in their homes had been studied and implemented only in a limited manner in the United States. However, during the COVID-19 Public...more
On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new nationwide audit of all skilled nursing facilities (SNF) and Hospital swing bed providers that submit claims for reimbursement to Medicare...more
In October 6, 2021, the Deputy General for the United States Department of Justice (“DOJ”) announced a new “Civil Cyber-Fraud Initiative” (the “Cyber-Fraud Initiative”) as part of the DOJ’s ongoing efforts to combat new and...more
At the end of January 2022, President Biden announced that the Covid-19 Public Health Emergency (PHE) will end on May 11, 2023. At that time, the Medicaid Program “continuous enrollment provision” will end and State Medicaid...more
On November 23, 2022, the Department of Health and Human Services and the Center for Medicare and Medicaid Services (“CMS”) passed a final rule that drastically changed the risk categories for certain providers when they...more
Efforts to reduce avoidable inpatient hospitalizations among nursing facility residents have been ongoing for years. As an example of these initiatives, CMS ran a program from 2012 to 2020 focusing on long-stay long-term...more
The current extension of the federal public health emergency declared as a result of the COVID-19 pandemic (“PHE”) will expire on October 15, 2022. As the need wanes for the waivers and flexibilities implemented due to the...more
The Centers for Medicare & Medicaid Services (“CMS”) issued updated guidance on July 11, 2022, reinforcing the federal Emergency Medical Treatment and Labor Act (“EMTALA”) obligations specific to patients who come to a...more
The Supplemental Medical Review Contractor (“SMRC”) is a Centers for Medicare and Medicaid Services (“CMS”) contractor authorized to conduct nationwide medical reviews (Medicare Part A, Part B, and DME). As many in the...more
On December 10, 2021 a hospital in Illinois made the news when it was reported that Gibson Area Hospital had agreed to pay $292,000 to settle False Claims Act (“FCA”) allegations of failing to return overpayments received...more
By now, if you are a provider who received Provider Relief Funds, you are familiar with the related reporting requirements on the use of the Funds. But do you also have an obligation to conduct a mandatory Single Audit? ...more
The Centers for Medicare and Medicaid Services (CMS) announced that Targeted Probe and Educate (TPE) audits would resume on September 1, 2021. TPE audits had been suspended by CMS during the public health emergency. Unlike...more
The next time you step into an emergency room, you may learn the hospital can provide you with hospital-level services to treat your illness in your home. Until recently, the idea of hospitals providing services to patients...more
The Pandemic led to a rise in the use of telehealth and a recognition of its value. When the COVID-19 pandemic began, the use of telehealth to provide healthcare services and enhance access to health care grew at an...more
Over the last 25 years, I have assisted healthcare providers as a lawyer and as a compliance professional with handling routine overpayment matters, internal and external billing investigations, and fraud and abuse matters. ...more
The scope and State enforcement related to visitation in nursing home and assisted living facilities in South Carolina is controversial and evolving on a regular basis. In recent weeks the South Carolina Department of...more
The laws and policies surrounding the financial relationship between payors and healthcare providers is healthcare reimbursement law. Our attorneys and consultants have broad experience handling matters involving the full...more
On August 26, 2020, the Centers for Medicare & Medicaid Services (CMS) released extensive COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service Billing and certain provisions of the Coronavirus Aid, Relief,...more