Gregory Etzel on Medicare

CMS Defers Low Wage Index Hospital Policy Changes in FY 2025 IPPS Final Rule Despite DC Circuit Holding

The Centers for Medicare and Medicaid Services (CMS) has deferred taking immediate action on its low wage index hospital policy in light of the US Court of Appeals for the DC Circuit’s decision in Bridgeport Hospital v....more

9/17/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare

How the End of the PHE Will Impact the Healthcare Industry

The Biden administration announced on January 30, 2023 that the COVID-19 Public Health Emergency (PHE) would officially end on May 11, 2023. The PHE declaration, which first was issued by the Secretary of the US Department of...more

5/11/2023 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Emergency Use Authorization (EUA) , Food and Drug Administration (FDA) , Life Sciences , Medicare , OCR , Public Health Emergency , Telehealth

Flawed Formula Drives Academic Medical Center Underpayments; Impacted Hospitals Should Consider Preserving Right to Payment

In the complex world of Medicare reimbursement, there are a multitude of payment formulae, mathematical adjustments, and reimbursement calculations that translate congressional policy into operational payments for hospital...more

8/24/2021 / Centers for Medicare & Medicaid Services (CMS) , Graduate Medical Education , Health Care Providers , Hospitals , Medicare , Physician Medicare Reimbursements , Provider Reimbursement Manual

CMS to Restart Medicare Audits Beginning August 3

The Centers for Medicare and Medicaid Services (CMS) recently announced that it intends to resume both prepayment and postpayment medical reviews conducted by the Medicare Administrative Contractors, Supplemental Medical...more

7/20/2020 / Audits , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Independent Medical Review , Medicare , Regulatory Requirements , Relief Measures

DC Circuit Court: CMS Rule on Drug Pricing Disclosure Exceeds Statutory Authority

In an informative decision for challenging rules that portend government overreach, the US Court of Appeals for the District of Columbia Circuit upholds the invalidation of the Centers for Medicare and Medicare Services’ drug...more

6/22/2020 / Centers for Medicare & Medicaid Services (CMS) , Disclosure Requirements , Drug Pricing , Medicare , Pharmaceutical Industry , Prescription Drugs , Transparency

CARES Act Relief Funds Offer Aid to Healthcare Providers, but Certifications and Overly Creative Use of Funds Are a Fraud Risk

Medicare (and in the future Medicaid) providers that receive grant money under the CARES Act Relief Fund must pay close attention to the terms and conditions of the assistance and rigorously document how the funds are used to...more

4/23/2020 / CARES Act , Coronavirus/COVID-19 , False Claims Act (FCA) , Federal Loans , Financial Stimulus , Health Care Providers , Medicaid , Medicare , Relief Measures

Medicare Accelerated/Advanced Payment Program — Medicare Administrative Contractors Update Application Forms/Process

Not to be confused with the $100 billion in Provider Relief Funds established as grants to healthcare providers through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Congress also broadened the access to...more

4/16/2020 / Advanced Payment Program , CARES Act , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Medicare

CMS Implements Massive Rule Change To Bolster Telehealth Amid COVID-19: What Providers Need To Know To Serve Their Patients

On March 30, 2020, the Centers for Medicare & Medicaid Services released a stunning and far-reaching interim final rule to address the coronavirus (COVID-19) crisis. The rule is a comprehensive set of policy changes designed...more

4/7/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Interim Final Rules (IFR) , Medicare , Relief Measures , Telehealth , Telemedicine

The President’s Emergency Declaration, Waivers, and the Current State of Regulations Applied to Healthcare Providers

In the face of the coronavirus (COVID-19) pandemic, the US president’s National Emergency Declaration, issued on March 13, set in motion several actions required of other agencies to provide the regulatory relief needed to...more

3/20/2020 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Emergency Management Plans , EMTALA , Health Care Providers , Healthcare Facilities , Healthcare Workers , Medicaid , Medicare , Stark Law , Trump Administration , Waivers

HHS Analyzes Legal Impact of Allina on Agency Enforcement

The US Department of Health and Human Services (HHS) Office of General Counsel (OGC) offered the healthcare industry the benefit of its legal analysis of the recent US Supreme Court opinion in Azar v. Allina Health Services...more

12/10/2019 / Administrative Procedure Act , Azar v Allina Health Services , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Hospitals , Low-Income Issues , Medicare , Medicare Advantage , Medicare Part A , Medicare Part C , Notice and Comment , Pay Reductions , Provider Payments , Reaffirmation , Retroactive Application , SCOTUS , Substantive Rule , Vacated

CMS Forges Ahead with Price Transparency, Major Payment Reductions in Proposed OPPS Rule

The Centers for Medicare and Medicaid Services’ proposed outpatient prospective payment system rule contains a number of significant changes and proposals impacting hospital operations and payments in calendar year 2020,...more

8/14/2019 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Hospitals , Medicaid , Medicare , Outpatient Prospective Payment System (OPPS) , Price Transparency , Section 340B , Two-Midnight Rule , Wage Index

US Supreme Court: CMS Must Follow Notice and Comment Rulemaking for Medicare Policy Changes with Substantive Legal Effect

In an opinion of significant importance to the administration of the Medicare program, the US Supreme Court issued a 7–1 decision requiring the Centers for Medicare & Medicaid Services (CMS) to follow notice and comment...more

6/5/2019 / Administrative Procedure Act , Centers for Medicare & Medicaid Services (CMS) , Medicare , SCOTUS

Something Old, Something New: The Proposed Medicare Physician Fee Schedule Rule

Mixing innovative change with standing policy, the proposed physician fee schedule rule for CY 2019 highlights a Medicare payment system in transition. Clinicians and groups focused solely on driving volume without devoting...more

7/25/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Physician Fee Schedule , Physicians

CMS Publishes Six Proposed Medicare Payment Rules: What It All Means

Key themes emerging from the hundreds of pages of proposed Medicare payment and policy rules impacting hospitals and post-acute providers include encouraging price transparency, promoting exchange of healthcare data, and...more

5/14/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare

Gregory Etzel

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