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McDermott+

September 2025 CPT Editorial Panel meeting: what’s on the agenda and why it matters

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The American Medical Association (AMA) CPT®* Editorial Panel will convene in Chicago, Illinois, from September 18 to 20, 2025. The meeting agenda includes proposals to create new current procedural terminology (CPT) codes and...more

Holland & Knight LLP

CMS Releases FY 2025 Inpatient Prospective Payment System Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) on April 10, 2024, released a proposed rule for the fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System...more

Jackson Lewis P.C.

How to Keep Physicians Happy Without Breaking Your Budget

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Budgeting remains a critical issue as more hospitals and medical groups merge or become acquired in 2023. Budgeting questions commonly require a comprehensive review of physician compensation agreements....more

Polsinelli

CMS Delays Price Transparency, Doubles Down on Site-Neutral and 340B Payment Policies in CY 2020 OPPS Final Rule

Polsinelli on

Late last week, the Centers for Medicare & Medicaid Services (“CMS”) released the CY 2020 Hospital Outpatient Prospective Payment System (“OPPS”) final rule [CMS-1717-FC]. While many hospitals had hoped for relief from recent...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 37. News Briefs - October 2019 #2

Health Care Compliance Association (HCCA) on

California physician Donald Woo Lee was found guilty Oct. 17 for his role in providing medically unnecessary procedures to Medicare beneficiaries, upcoding, and repackaging single-use catheters for re-use, the Department of...more

Health Care Compliance Association (HCCA)

As New SNF Payment System Takes Effect, CMS Will Monitor Changes in Therapy, Coding

Health Care Compliance Association (HCCA) on

Starting Oct. 1, per diem payments to skilled nursing facilities (SNFs) will be more generous on the first few days of a Medicare beneficiary’s stay, and then drop as the stay continues. That’s one of the changes under the...more

Baker Donelson

Plausibility Requirement for Pleading in FCA Cases Remains a Viable Defensive Tool

Baker Donelson on

The recent federal court opinion issued in United States ex rel. Integra Med Analytics, LLC v. Baylor Scott & White Health, et al, illustrates the continued importance of examining the plausibility of allegations made in qui...more

Foley & Lardner LLP

Health Care MarketTrends - September 2019, Issue 2

Foley & Lardner LLP on

Welcome to Foley & Lardner LLP’s Health Care MarketTrends. In this issue, we examine private equity investment in specialty areas of the health care industry, specifically dermatology and orthopedics....more

Dorsey & Whitney LLP

Relator Failed to Sufficiently Plead its FCA Action by Relying on Big Data Alone, Resulting In Big Dismissal

Dorsey & Whitney LLP on

In early August, the U.S. District Court for the Western District of Texas granted a hospital system’s motion to dismiss a False Claims Act case that illustrates the increasing intersections in FCA litigation between data...more

Robinson+Cole Health Law Diagnosis

One-Two Punch: On Consecutive Days, DOJ Announces High Dollar Fraud and Abuse Settlements with Hospitals

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The Department of Justice (DOJ) announced two significant False Claims Act (FCA) settlements in recent days that signal continued close government scrutiny of billing, coding and referral practices at hospitals....more

Bradley Arant Boult Cummings LLP

CMS Proposes Significant E/M Coding and Documentation Changes - Healthcare Alert

Bradley Arant Boult Cummings LLP on

On July 27, 2018, the Centers for Medicare & Medicaid Services (CMS) published its proposed annual update to the Medicare Physician Fee Schedule, which proposes changes to the E/M coding and documentation process that CMS...more

Akin Gump Strauss Hauer & Feld LLP

New CMS National Coverage Determination and FDA Regulatory Approach: the Next Generation for NGS Testing Policy?

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• The new national Medicare coverage determination covers only FDA-authorized NGS tests with companion diagnostic indications, leaving NGS cancer tests without that specific indication to seek coverage from local Medicare...more

Womble Bond Dickinson

Use of Modifier 25 - 2017 Medicare Physician Fee Schedule Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have reviewed the use of Modifier 25 to unbundle payments for evaluation and management (E/M) services when a procedure is...more

Mintz - Health Care Viewpoints

MA Risk Adjustment in the 2016 Call Letter and … in Health Care Fraud Charges

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In past Call Letters, CMS has proposed and finalized significant changes to the Medicare Advantage risk adjustment system including, recalibrations, deletions and additions of diagnoses codes, and questioning of the value of...more

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