John Tilton on Centers for Medicare & Medicaid Services (CMS)

Medicare Advantage RADV Audit Final Rule Challenged in Court

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. Among other...more

9/28/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs)

CMS Announces Changes to ACO REACH Model

On August 14, 2023, the Centers for Medicare & Medicaid Services (CMS) released guidance on changes to the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model starting in performance...more

9/12/2023 / Centers for Medicare & Medicaid Services (CMS) , CMMI , Health Insurance , Innovation , Medicare , New Regulations , REACH , Regulatory Agenda

CMS Announces Proposed Rule for 2024 Medicare Physician Fee Schedule

On July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Physician Fee Schedule (“PFS”). The Proposed Rule, which was issued in the Federal...more

8/14/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physician Medicare Reimbursements , Physicians , Proposed Rules

CMS Issues Long-Awaiting Medicare Advantage RADV Final Rule

On January 30, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final...more

2/2/2023 / Audits , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Final Rules , Medicare , Medicare Advantage , Medicare Advantage Organizations (MAOs) , OIG , Overpayment Recovery Time Limits

CMS Pushes Publication of Final FFS Adjuster for RADV Audits Rule to February 1, 2023

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster)...more

11/2/2022 / Audits , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Medicare Advantage Organizations (MAOs) , Medicare Part A , Medicare Part B , Social Security Act

The Other Shoe Drops: OIG To Audit COVID-19 Telehealth Home Health Services

In response to the ongoing COVID-19 public health emergency (the “PHE”) first declared on March 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued blanket Section 1135 Waivers to expand, albeit on a...more

2/1/2021 / 1135 Waivers , Audits , Centers for Medicare & Medicaid Services (CMS) , Coronavirus/COVID-19 , Home Health Care , Medicare , OIG , Public Health Emergency , Telehealth , Waivers

CMS’s Mandatory Radiation Oncology Payment Model: Negative Reactions in the Radiation Oncology Treatment Community

On July 10 2019, the Centers for Medicare & Medicaid Services (“CMS”) issued a Notice of Proposed Rulemaking (“NPR”) entitled, “Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures.” In...more

10/29/2019 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Medicare , Patient Access and Medicare Protection Act , Payment Systems , Quality of Care Standards

Information Blocking And The Right To Access Initiative: Why Patients Struggle to Obtain their Medical Records and what the Office...

Access to healthcare information (or lack thereof) has always been touted as one of the key factors/necessities to realizing the promise of technology in the delivery of healthcare. Despite various legislative, judicial,...more

10/18/2019 / 21st Century Cures Act , Centers for Medicare & Medicaid Services (CMS) , Data Blocking , Department of Health and Human Services (HHS) , Electronic Protected Health Information (ePHI) , Enforcement Actions , Health Care Providers , Health Information Technologies , Health Insurance Portability and Accountability Act (HIPAA) , HIPAA Breach , Medical Records , OCR , Proposed Rules , Public Policy , Records Request , Right of Access , Risk Management

John Tilton

Sheppard Mullin Richter & Hampton LLP

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