On April 27,2022, the Office of Inspector General of the Department of Health and Human Services (OIG), Office of Evaluations and Inspections, issued a report on the performance of Medicare Advantage Organizations (MAOs) in...more
On September 30, 2021, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury (collectively, the Departments) along with the Office of Management and Budget released “Requirements Related to Surprise...more
On September 20, 2021 the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report suggesting that certain Medicare Advantage (MA) companies were leveraging chart reviews and...more
Over the last several years, both the federal government and a number of state legislatures have sought to find a solution to the billing by out-of-network providers, referred to as “Out of Network Billing” (OON Billing) and...more
By letter dated April 13, 2021 (Letter), the Democrat and Republican leadership of the House Committee on Energy and Commerce and its Subcommittee on Health, wrote United States Health and Human Services Secretary, Xavier...more
On December 29, 2020, the United States Court of Appeals for the District of Columbia issued its opinion in American Hospital Association v. Azar (the Opinion) upholding the Hospital Transparency Regulation (the Rule) issued...more
1/13/2021
/ Administrative Procedure Act ,
Affordable Care Act ,
American Hospital Association ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Corrective Action Plans (CAPs) ,
Department of Health and Human Services (HHS) ,
First Amendment ,
Hospitals ,
New Regulations ,
New Rules ,
PHSA ,
Price Transparency ,
Public Disclosure ,
Secretary of HHS
On October 29, 2020 the United States Departments of Health and Human Services, Labor and Treasury (the Departments) issued a final rule entitled Transparency in Coverage (the Rule). The Rule continues on the Trump...more
11/5/2020
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Executive Orders ,
Final Rules ,
HCPCS ,
Health Insurance ,
Pharmacy Benefit Manager (PBM) ,
Public Disclosure ,
TPAs ,
Transparency ,
U.S. Treasury
On July 10, 2019, President Trump issued an Executive Order entitled Advancing American Kidney Health. The Executive Order stated that the “state of care for patients with chronic kidney disease and end-stage renal disease...more
On November 15, 2019, the Federal Government issued two rules: one in final form and one in proposed form, both designed to increase price transparency in health care. The rules follow on the Executive Order announced by...more
12/27/2019
/ Affordable Care Act ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Employer Group Health Plans ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Hospitals ,
Price Transparency ,
Proposed Rules
On July 10, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare & Medicaid Innovation (Innovation Center) released a much awaited proposal for a new bundled payment model for radiation...more
8/6/2019
/ Bundled Payments ,
Cancer ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicare ,
NPRM ,
Proposed Rules ,
Quality of Care Standards
Despite some initial difficulty in gaining momentum, the use of value-based payment methodologies will likely increase across all provider niches. This change is partly a function of cost savings driven by margin compression...more
On January 9, 2018, The Centers for Medicare & Medicaid Services (CMS) announced a new voluntary bundled payment model program – Bundled Payment for Care Improvement Advanced (BPCI Advanced). The episode payment model, which...more
On December 27, 2013, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) finalized amendments to the Physician Self-Referral Law (Stark) and...more