On Aug. 25, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (IFR) as an emergency regulation under the public health emergency (PHE). Under the IFR, CMS will require all hospitals to which...more
The Centers for Medicare & Medicaid Services (CMS) on Aug. 4, 2020, published the Calendar Year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed...more
The Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2021 Proposed Rule for the Medicare Physician Fee Schedule (MPFS), which contains updates to the Quality Payment Program (QPP). The MPFS...more
Before the pandemic, telehealth coverage was limited in scope. However, the Centers for Medicare & Medicaid Services (CMS) recently expanded coverage through its regulatory authority and waivers to encourage broad adoption of...more
The Centers for Medicare & Medicaid Services (CMS) released on May 11, 2020, the Fiscal Year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment...more
Congress has provided an unprecedented infusion of funding and other financial relief through a variety of new and existing programs to address the coronavirus (COVID-19) outbreak. This blog post outlines how the federal...more
3/31/2020
/ CARES Act ,
Centers for Disease Control and Prevention (CDC) ,
Coronavirus/COVID-19 ,
Federal Funding ,
Financial Stimulus ,
Health Care Providers ,
Hospitals ,
Medicare ,
National Institute of Health (NIH) ,
Public Health ,
Public Health Emergency ,
Relief Measures
On the day following the enactment of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), the Centers for Medicare & Medicaid Services (CMS) made clear its intention to expand the groups of medical...more
On March 6, Congress passed the Coronavirus Supplemental Appropriations Act (H.R. 6074), which included a $500 million authorization to enhance telehealth services. The legislation gives the U.S. Department of Health and...more
3/25/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Emergency Response ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicaid ,
Medicare ,
OIG ,
Relief Measures ,
Telehealth ,
Telemedicine
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2019, released the Calendar Year (CY) 2020 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule....more
11/13/2019
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Community Health Systems ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Rural Health Care Providers ,
Section 340B ,
Transparency
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2019, published the Calendar Year (CY) 2020 Final Rule for the Medicare Physician Fee Schedule (MPFS). The MPFS dictates Medicare rates and policies under Part B,...more
11/11/2019
/ Alternative Payment Models (APM) ,
Ambulance Providers ,
Bundled Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Treatment ,
Final Rules ,
Health Care Providers ,
Medical Records ,
Medicare ,
Medicare Part B ,
MIPS ,
Open Payments ,
Opioid ,
PHI ,
Physician Fee Schedule ,
Physicians ,
Public Comment ,
Quality Payment Program (QPP) ,
Substance Abuse ,
Telehealth
On August 2, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital Prospective Payment System...more
8/9/2019
/ Applications ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Inpatient Quality Reporting ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Payment Systems ,
Proposed Rules ,
Public Comment ,
Rulemaking Process ,
Value-Based Purchasing ,
Wage Index
• The Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2020 Proposed Rule for the Medicare Physician Fee Schedule (MPFS). The MPFS dictates Medicare rates and policies under Part B, while the...more
8/7/2019
/ Alternative Payment Models (APM) ,
Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Medicare ,
Medicare Shared Savings Program ,
MIPS ,
MPFS ,
Notice of Proposed Rulemaking (NOPR) ,
Physician Fee Schedule ,
Physicians ,
Proposed Rules ,
Telehealth
The Centers for Medicare & Medicaid Services (CMS) announced five new, voluntary value-based payment models for primary care: Primary Care First and Direct Contracting. Applications are expected to open shortly, and both...more
President Trump's budget was released yesterday as the fiscal year (FY) 2020 appropriations process ramps up. The FY 2020 budget requests $87.1 billion in discretionary funding for the Health and Human Services (HHS)...more
3/14/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Emergency Rooms ,
Federal Budget ,
FQHC ,
Health Care Providers ,
Medicaid ,
Medicare ,
Public Health ,
Trump Administration ,
Veterans Administration
On Jan. 31, 2019, the Department of Health and Human Services' (HHS) Office of the Inspector General (OIG) issued a long-awaited proposed rule that would, if finalized, remove the existing legal "safe harbor" that protects...more
2/5/2019
/ Comment Period ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Exemptions ,
Health Care Providers ,
Health Plan Sponsors ,
Manufacturers ,
MCOs ,
Medicaid ,
Medicare ,
Medicare Part D ,
OIG ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Proposed Rules ,
Public Comment ,
Rebates ,
Safe Harbors ,
Trump Administration
• The Centers for Medicare & Medicaid Services (CMS) has issued the Calendar Year (CY) 2019 Final Rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory...more
11/13/2018
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Data Collection ,
Emergency Rooms ,
Final Rules ,
Health Care Providers ,
Health Clinics ,
Hospitals ,
Medicare ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Payment Rates ,
Physician Fee Schedule ,
Physician Medicare Reimbursements ,
Physicians ,
Policies and Procedures ,
Prescription Drugs ,
Section 340B
Healthcare was a top voter priority in the 2018 midterm elections, with 41 percent of national voters stating that healthcare was their "most important" issue. Accordingly, the Democratic strategy to focus on healthcare...more
11/13/2018
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Legislative Agendas ,
Medicaid ,
Medicaid Expansion ,
Medicare ,
Trump Administration
• The Centers for Medicare & Medicaid Services (CMS) has published the Calendar Year (CY) 2019 Final Rule for the Medicare Physician Fee Schedule (PFS), which includes provisions related to Medicare physician payments as well...more
11/7/2018
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
Hospitals ,
Medicare ,
Medicare Part B ,
MIPS ,
MPFS ,
Pharmaceutical Industry ,
Pharmacies ,
Physician Medicare Reimbursements ,
Physician Payments ,
Physicians ,
Policies and Procedures ,
Prescription Drugs ,
Quality Payment Program (QPP) ,
Telehealth
The Centers for Medicare & Medicaid Services (CMS) on July 12, 2018, published the CY 2019 Proposed Rule for the Medicare Physician Fee Schedule (PFS). While in previous years regulations for the Quality Payment Program (QPP)...more
7/23/2018
/ Alternative Payment Models (APM) ,
Bi-Partison Balanced Budget Act (BBA) ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Health Care Providers ,
Medicare ,
Medicare Part B ,
MIPS ,
Outpatient Services ,
Pharmaceutical Industry ,
Physician Fee Schedule ,
Physicians ,
Proposed Rules ,
Public Comment ,
Quality Payment Program (QPP) ,
Reporting Requirements ,
Telehealth
Enforcement -
OIG Issues Advisory Opinion on Provision of Samples by a Device Distributor -
On April 30, 2018, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a...more
5/30/2018
/ Adverse Action ,
Advisory Opinions ,
Affordable Care Act ,
Anti-Kickback Statute ,
Antitrust Litigation ,
Beneficiaries ,
Biosimilars ,
CMMI ,
Competition ,
Constructive Discharge ,
Department of Health and Human Services (HHS) ,
Distributors ,
Drug Pricing ,
Employer Liability Issues ,
Enforcement ,
Failure To State A Claim ,
False Claims Act (FCA) ,
FDCPA ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Kickbacks ,
Manufacturers ,
Medicaid ,
Medicare ,
Medicare Part B ,
Medicare Part D ,
OIG ,
Patients ,
Pharmaceutical Industry ,
Pharmacies ,
Request For Information ,
Section 340B ,
Sherman Act ,
Statute of Limitations
On Feb. 9, 2018, Congress passed and President Donald Trump signed into law the Bipartisan Budget Act of 2018 (BBA). This wide-reaching legislation enacts major changes for telehealth policy in Medicare by incorporating...more
4/17/2018
/ Bi-Partison Balanced Budget Act (BBA) ,
Centers for Medicare & Medicaid Services (CMS) ,
DEA ,
Department of Health and Human Services (HHS) ,
ESRD ,
FQHC ,
Health Care Providers ,
Health Information Technologies ,
HELP Act ,
Home Health Care ,
Medicare ,
Medicare Advantage ,
OIG ,
Physician Fee Schedule ,
Prescription Drugs ,
Ryan Haight Act ,
Telehealth ,
Telemedicine ,
Ways and Means Committee
On Feb. 9, 2018, the Trump Administration released a 30-page report analyzing domestic and global factors influencing drug pricing. The report by the Council of Economic Advisers (CEA) is expected to inform the HHS' Fiscal...more
2/13/2018
/ Antitrust Provisions ,
Biosimilars ,
Budget Reconciliation ,
Centers for Medicare & Medicaid Services (CMS) ,
Commodity Exchange Act (CEA) ,
Cross-Border Transactions ,
Department of Health and Human Services (HHS) ,
Drug Pricing ,
Federal Budget ,
Fixed Price ,
Food and Drug Administration (FDA) ,
GAO ,
Health Care Providers ,
Incentives ,
Manufacturers ,
Medicaid ,
Medicare ,
Medicare Part B ,
Medicare Part D ,
MedPAC ,
OIG ,
Outpatient Services ,
Pharmaceutical Industry ,
Physician Medicare Reimbursements ,
Prescription Drugs ,
Price-Fixing ,
Rebates ,
Secretary of HHS ,
Section 340B ,
Social Security Act ,
Supply Chain ,
Trump Administration
Congress moved one step closer to avoiding a government shutdown on Feb. 6, voting overwhelmingly (245-182) to pass a short-term, GOP-backed government funding bill (text; section-by-section) that would keep the federal...more
2/9/2018
/ 21st Century Cures Act ,
Affordable Care Act ,
Budget Cuts ,
Children's Health Insurance Program (CHIP) ,
Department of Defense (DOD) ,
Federal Budget ,
Federal Funding ,
Government Shutdown ,
Health Care Providers ,
Health Insurance ,
Healthcare Costs ,
Hospitals ,
IPAB ,
Legislative Agendas ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIECHV Program ,
National Health Service Corp (NHSC) ,
National Institute of Health (NIH) ,
Offsets ,
Physicians ,
Public Health ,
Tax Extenders ,
Trump Administration
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2017, released the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Final Rule for...more
11/13/2017
/ ADLT ,
Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Hospitals ,
Laboratories ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
MPFS ,
Outpatient Prospective Payment System (OPPS) ,
Payment Rates ,
Physicians ,
Policies and Procedures ,
Prescription Drugs ,
Quality Payment Program (QPP)
The Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016, released the highly anticipated Final Rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP...more
10/20/2016
/ ACOs ,
Affordable Care Act ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Electronic Health Record Incentives ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
Nurse Practitioners ,
Physician Assistants ,
Physician Medicare Reimbursements ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR) ,
Value-Based Payments