Jenna Godlewski at Maynard Nexsen

Changing Hospice Certifying Physician Enrollment: Starting in June, Physicians Must Be Enrolled or Opted-Out of Medicare for CMS...

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

5/8/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physicians

CMS Allows for the Coverage of Marriage and Family Therapists and Mental Health Counselors Services

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

12/13/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Part B , Mental Health , Telehealth

Billing Medicare or Medicaid? Understanding Your Audit Risk

If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit...more

7/12/2023 / Centers for Medicare & Medicaid Services (CMS) , Medicaid , Medicare , Medicare Administrative Contractors (MAC) , OIG , Recovery Audit Contractors (RACs) , Skilled Nursing Facility , SMRC

The End of PHE Flexibilities – How to Navigate Upcoming Changes in Healthcare

On January 30, 2022, President Biden announced that the Covid-19 Public Health Emergency (PHE) will finally end on May 11, 2023.[1] Since the PHE was declared on January 31, 2020, emergency declarations and waivers were...more

2/17/2023 / Centers for Medicare & Medicaid Services (CMS) , Children's Health Insurance Program (CHIP) , Coronavirus/COVID-19 , Infectious Diseases , Medicaid , Medicare , Public Health Emergency , Skilled Nursing Facility , Telehealth

South Carolina Medicaid to Restart Member Eligibility Reviews – Details and Action Steps for Providers and Their Medicaid...

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

2/17/2023 / Coronavirus/COVID-19 , Health Care Providers , Medicaid , Public Health Emergency

CMS Designates More Providers as “High Risk”

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

12/7/2022 / Background Checks , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Skilled Nursing Facility

CMS Revocation and Preclusion: The “Secret” Exclusion

On April 1, 2019, the Center for Medicare and Medicaid Services (“CMS”) announced a new exclusion sanction: the CMS Preclusion List. This lesser-known sanction is different than placement on the Office of Inspector General...more

9/19/2022 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Advantage , Medicare Part D , OIG

CMS Directs Providers to “Prepare to Return to Normal”- Getting Ready for the

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

8/23/2022 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Hospitals , Physicians

State Abortion Laws v. EMTALA: Navigating Between a Rock and a Hard Place

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

7/20/2022 / Abortion , Centers for Medicare & Medicaid Services (CMS) , EMTALA , Health Care Providers , Hospitals

Understanding the CMS 2022 Strategic Plan: Six Trends to Follow

The Centers for Medicare and Medicaid Services (“CMS”) issued its 2022 Strategic Framework (“CMS Strategic Framework”) on June 8, 2022. Although styled as an open letter and visionary plan, key trends affecting providers now...more

7/13/2022 / ACOs , Centers for Medicare & Medicaid Services (CMS) , CMMI , Food and Drug Administration (FDA) , Prescription Drugs

CMS Affirms Access to Reproductive Health Care on Same Day Supreme Court Strikes Down Roe v. Wade

Friday, June 24, 2022, began with the United States Supreme Court’s publication of its decision to overturn Roe v. Wade. In Dobbs v. Jackson Women’s Health Organization (19-1392), the Supreme Court held: “The Constitution...more

6/28/2022 / Abortion , Centers for Medicare & Medicaid Services (CMS) , Dobbs v. Jackson Women’s Health Organization , Reproductive Healthcare Issues , Roe v Wade , SCOTUS , Women's Rights

SMRC Targets for 2022: After Heavy Focus on Hospice, the SMRC Moves On to Home Health and Other Projects

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

2/1/2022 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Home Health Care , Hospice , OIG , Skilled Nursing Facility , SMRC , Telehealth

Increased Enforcement Means Need to Review Credit Balance Procedures

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

1/6/2022 / Centers for Medicare & Medicaid Services (CMS) , False Claims Act (FCA) , Health Care Providers , Hospitals , Medicaid

TPE Audits Are Back: What Providers Need to Know

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

9/7/2021 / Audits , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare Administrative Contractors (MAC)

SMRC Intensified Auditing in 2021: What is a Supplemental Medical Review Contractor and What Are They Auditing?

The year 2020 saw much less medical review auditing, including a CMS suspension of audits between March 30 and August 3 of 2020. However, with the lifting of the CMS suspension, the CMS Supplemental Medical Review Contractor...more

6/14/2021 / Centers for Medicare & Medicaid Services (CMS) , GAO , MACs , Medicare , SMRC

Rapid Rise in Telehealth Leads to Significant Oversight: How to Prepare Now for New Audit Activities

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

3/22/2021 / Coronavirus/COVID-19 , Health Care Providers , OIG , Telehealth

Behavioral Health Scores a Big Win with Telehealth Waivers During Pandemic, but Audit Risks are High

BackgroundPrior to the current public health emergency (PHE), Medicare allowed for coverage of telehealth services primarily in rural areas where beneficiaries had difficulty accessing quality health care. Based on the...more

2/17/2021 / Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Department of Health and Human Services (HHS) , Health Insurance Portability and Accountability Act (HIPAA) , Medicare , OCR , Public Health Emergency , Telehealth

To Combat COVID-19 Surge, CMS Expands the “Hospitals Without Walls” Program by Launching the “Acute Hospital Care At Home”...

As hospitalizations due to COVID-19 reach records levels across the country, the Centers for Medicare & Medicaid Services (CMS) rolled out an unprecedented comprehensive strategy to increase hospital capacity as part of the...more

12/8/2020 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Health Care Providers , Healthcare Facilities , Hospitals

Health Care Reimbursement: Experience Matters. The Who, What, When, Where, and Why of Healthcare Reimbursement Coverage,...

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

9/22/2020 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicaid , Medicare , Reimbursements , TRICARE

Jenna Godlewski

Maynard Nexsen

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