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Medicare › Medicare Part B › Compliance

ArentFox Schiff

Medicare 2026 Proposed Rules, Major Drug Pricing Updates, and What Stakeholders Need to Know

ArentFox Schiff on

Every July, the Centers for Medicare & Medicaid Services (CMS) publishes two proposed rules that set Medicare reimbursement and shape the administration of the Medicare Part B program for the upcoming calendar year. These...more

Hendershot Cowart P.C.

Qlarant, Novitas Audits Escalate as Medicare Skin Substitutes Spending Hits $1.6 Billion, CMS Seeks Evidence of Clinical...

Hendershot Cowart P.C. on

The wound care industry faces unprecedented scrutiny as Medicare Part B expenditures for skin substitutes exceeded $1.6 billion in the fourth quarter of 2023 alone. The spending surge has triggered a wave of skin substitute...more

Health Care Compliance Association (HCCA)

Privacy Briefs: September 2024

Health Care Compliance Association (HCCA) on

The HHS Centers for Medicare & Medicaid Services (CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) are notifying 946,801 people whose protected health information or other personally identifiable information...more

Foley & Lardner LLP

Medicare Compliance Basics: “Incident to” Billing

Foley & Lardner LLP on

Editor’s Note: We are excited to announce that this article is the first of a series addressing Medicare Part B’s “incident to” billing requirements, designed to give practical guidance and orientation to health care...more

Sheppard Mullin Richter & Hampton LLP

Healthcare Reforms Under the IRA: Expanding Access to Care

Sheppard Mullin Richter & Hampton LLP on

The Inflation Reduction Act (“IRA”) was signed into law by President Biden on August 16, 2022. The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, Medicare Part...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 11. News Briefs: March 2020 #3

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 29, no. 11 (March 23, 2020) - There are signs of life to the national hospital reviews of short stays and high-weighted MS-DRGs (HWDRGs). A CMS spokesperson said Avar Consulting, a...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 28, Number 42. News Briefs: November 2019 #4

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 28, no. 42 (November 25, 2019) - In a surprising CMS memo that just surfaced, top CMS attorneys echo the sentiments of the Department of Justice about the limits of enforcement actions based...more

Baker Donelson

OIG Unveils New Work Plan Process: Assessing the Impact on Compliance Risk Assessment

Baker Donelson on

On June and July 17, 2017, the Department of Health and Human Services, Office of Inspector General (OIG) released new Work Plan initiatives and, in doing so, announced its intent to update its Work Plan monthly, in lieu of a...more

BakerHostetler

Kane and the “60-Day Rule”: The Unforgiving World of Medicare and Medicaid Overpayments

BakerHostetler on

The Southern District of New York has spoken on one of the first issues to confront those seeking compliance with the new “60-day rule” under the Affordable Care Act (ACA), and it does not bode well for defendant hospitals...more

BakerHostetler

Proposed Rule Aims to Refine Stark Regulations and Clarify “Incident To”

BakerHostetler on

On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2016 Physician Fee Schedule Proposed Rule. In addition to updating several traditional Part B payment policies, the...more

Morgan Lewis

Sixty Days of Gray: Medicare and Medicaid Refund Requirements - Hospital Industry Viewpoint

Morgan Lewis on

Although CMS has not yet issued a final rule on the ACA’s 60-day repayment provisions, hospitals and other providers can still create policies and train staff in a manner that gives them some measure of protection. Even with...more

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