As the new administration continues its efforts to contract and streamline the federal government, recent developments at the U.S. Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) hint at...more
One could forgive the healthcare industry for thinking someone drove Doc Brown’s DeLorean time machine through One First Street when it awoke on Friday, June 28, to a blast from the past....more
7/11/2024
/ Administrative Procedure Act ,
Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Chevron Deference ,
Government Agencies ,
Health Care Providers ,
Judicial Authority ,
Loper Bright Enterprises v Raimondo ,
Medical Reimbursement ,
Medicare ,
Overpayment ,
Regulatory Authority ,
SCOTUS ,
Statutory Interpretation
Recently, Optum Behavioral Health (“Optum,” the services division for UnitedHealth Group) has initiated overpayment recovery actions against numerous licensed clinical social workers (“LCSWs”) across the country for services...more
Co-Location and the Provider-Based Rules – No News is…Good News?
On July 15, the Centers for Medicare & Medicaid Services ("CMS") released the 2023 Outpatient Prospective Payment System proposed rule (“OPPS Proposed...more
9/15/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Critical Access Hospitals ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicare ,
No Surprises Act (NSA) ,
Outpatient Prospective Payment System (OPPS) ,
Payor Contracts ,
Surprise Medical Bills
The end of 2021 brings positive indications of the continued acceptance of telehealth as an important clinical care approach post public health emergency (“PHE”). The Centers for Medicare and Medicaid Services (“CMS”), like...more
2/22/2022
/ Ambulatory Surgery Centers ,
Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Medicare Advantage ,
Outpatient Prospective Payment System (OPPS) ,
Payor Contracts ,
Physician Fee Schedule ,
Section 340B ,
Surprise Medical Bills ,
Telehealth
On July 1, 2021, the Departments of Health and Human Services (“HHS”), Treasury, and Labor, along with the Office of Personnel Management (collectively the “Departments”), issued the first tranche of regulations implementing...more
9/30/2021
/ Biden Administration ,
Drug Pricing ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Interim Final Rules (IFR) ,
Legislative Agendas ,
Medical Reimbursement ,
Out of Network Provider ,
Price Transparency ,
Provider Relief Fund ,
Regulatory Agenda ,
Surprise Medical Bills ,
Value-Based Care
Strategies for Complying with Price Transparency and Surprise Billing Laws -
State legislatures and the federal government have been busy the past 12 months churning out laws that impose new disclosure and billing obligations...more
2/23/2021
/ Coronavirus/COVID-19 ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Infectious Diseases ,
Payor Contracts ,
Regulatory Agenda ,
Reimbursements ,
Surprise Medical Bills ,
Telehealth ,
Vaccinations ,
Value-Based Care
The Centers For Medicare & Medicaid Services Issues New Inpatient Prospective Payment System Final Rule -
On September 3, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2021 Medicare...more
12/31/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Cramdown ,
Drug Pricing ,
Health Care Providers ,
Healthcare Reform ,
Inpatient Prospective Payment System (IPPS) ,
Medicaid ,
Medicare ,
Physician Fee Schedule ,
Physician Medicare Reimbursements ,
Section 340B ,
Telehealth ,
Value-Based Care
Introduction -
CMS has taken extensive measures to assist providers and promote access to care in light of the Public Health Emergency (PHE) related to the COVID-19 pandemic. The efforts taken have and continue to benefit...more
8/4/2020
/ Audits ,
CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
COBRA ,
Coronavirus/COVID-19 ,
Health Care Providers ,
Health Insurance ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Skilled Nursing Facility ,
Telehealth ,
Telemedicine
On October 31, 2019, the Office of General Counsel for the U.S. Department of Health and Human Services (HHS) issued an important memo from Kelly M. Cleary, CMS Chief Legal Officer, and Brenna E. Jenny, Deputy General...more
12/5/2019
/ Administrative Procedure Act ,
Azar v Allina Health Services ,
Centers for Medicare & Medicaid Services (CMS) ,
Denial of Benefits ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Local Coverage Determination (LCD) ,
Low-Income Issues ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part C ,
Notice and Comment ,
Overpayment ,
Pay Reductions ,
Provider Payments ,
Reaffirmation ,
Retroactive Application ,
Rulemaking Process ,
SCOTUS ,
Substantive Rule ,
Universal Health Services Inc v United States ex rel Escobar ,
Vacated
On November 15, CMS issued the Price Transparency Requirements for Hospitals to Make Standards Charges Public Final Rule (“Final Rule”), as directed by President Donald Trump’s Executive Order on Improving Price and Quality...more
11/26/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Executive Orders ,
Final Rules ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
Medical Examinations ,
Medical Expenses ,
Pharmaceutical Industry ,
Pricing Requirements ,
Regulatory Requirements ,
Rulemaking Process ,
Service Charges ,
Surprise Medical Bills ,
Transparency ,
Trump Administration
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
...more
11/1/2019
/ Administrative Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Contract Disputes ,
Enrollment ,
Health Care Providers ,
Injunctive Relief ,
Managed Care Contracts ,
Medical Reimbursement ,
Medicare ,
Payor Contracts ,
Revocation ,
Site-Neutral Exception ,
Universal Health Services Inc v United States ex rel Escobar
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
...more
A recent ruling allows health care providers to seek relief from federal courts if the delay caused by the Medicare appeals backlog is likely to cause the provider irreparable injury....more
Recently HHS announced two initiatives to address the mounting Medicare appeals backlog at the Administrative Law Judge level: (i) expand the Settlement Conference -
Facilitation (SCF) program and (ii) offer a new Low...more
The LVA settlement option is being offered to providers and suppliers with fewer than 500 Part A and B claims pending as of Nov. 3, combined, where no single claim appeal exceeds $9,000. These appeals will be settled at 62...more
The Medicare Learning Network (MLN) recently held a second call, where it answered questions live about the Low Volume Appeals (LVA) Settlement Option and revealed more information that providers considering the option need...more
As required by last November's Bipartisan Budget Act of 2015, the Department of Justice on June 30 released an interim final rule making inflationary adjustments to civil monetary penalties under its jurisdiction, including...more
On Feb. 25, 2016, the Office of Medicare Hearings and Appeals (OMHA) conducted a teleconference to address Phase III of the Settlement Conference Facilitation (SCF) project, which also became effective on Feb. 25, 2016. SCF,...more
On Jan. 20, 2016, a federal district court in the Western District of Texas affirmed a decision of the Medical Appeals Council (Appeals Council) affirming a CMS contractor’s extrapolation methodology used to assess an...more
On February 12, 2016, CMS published the Reporting and Returning of Overpayments Final Rule (Final Rule). The Final Rule takes effect on March 14, 2016. Overall, CMS appears to have listened to stakeholders and acknowledged...more
The Centers for Medicare & Medicaid Services (“CMS”) announced that it has reduced the maximum percentage of records that providers must submit to Recovery Audit Contractors (“RAC”) through the payment auditing process...more