As we reported in our Managed Care Newsletter in April 2020, the CARES Act passed by Congress last year provides for a 20% increase to the DRG weights in the Medicare Inpatient Prospective Payment system (“IPPS”) for patients...more
Several health plans have announced that for certain services related to COVID-19 they are waiving patient financial responsibility – e.g., copays, coinsurance, deductibles, etc. The federal government has encouraged these...more
Section 4408 of the CARES Act suspends the 2% sequestration reduction to payments under the Medicare program that have been in place since April 1, 2013. The suspension of sequestration in Medicare will run from May 1, 2020...more
Hospitals that attempt to discharge a patient to a post-acute level of care but are not able to because they cannot find an appropriate accepting facility must continue providing care if the patient cannot be safely...more
12/16/2019
/ Acute Facilities ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Insurance ,
Health Insurance Exchanges ,
Hospitals ,
Knox Keene ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Provider Agreements ,
Qualified Health Plans
Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more
8/19/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Class Action ,
Constitutional Challenges ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Hospitals ,
Inpatient Billing ,
Managed Care Contracts ,
Medi-Cal ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
Two-Midnight Rule ,
Underpayment