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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

Hendershot Cowart P.C.

CMS, Qlarant Scrutinizing Medicare Claims for Skin Substitute Treatments

Hendershot Cowart P.C. on

Our firm is seeing an uptick in Medicare demand letters for the recovery of overpayment for skin substitutes, such as WoundFixTM, Biobrane, Dermagraft®, AmnioBand®, or AlloPatch®, used in the treatment of wounds. CMS auditors...more

Health Care Compliance Association (HCCA)

Enforcement actions relating to a lack of medical necessity

Health Care Compliance Association (HCCA) on

In a climate of shrinking margins, diminishing reimbursement, and frequent denials, healthcare organizations may make efforts to increase the volume of services they provide, especially those that are more profitable. Of...more

Oberheiden P.C.

Medicare TPE Audits: 7 Common Questions Answered

Oberheiden P.C. on

The Centers for Medicare and Medicaid Services (CMS) and its audit contractors have recently increased their use of Targeted Probe and Educate (TPE) audits to target providers suspected of improperly billing Medicare. While...more

Saul Ewing LLP

2021 Health Care Predictions

Saul Ewing LLP on

One year ago – in early 2020 – most of us did not know what COVID-19 meant (co-Corona; vi-Virus; d-disease; 19 – 2019); had no idea how to “zoom”; did not know what social distance meant; and, were largely unfamiliar with...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 30, Number 2. News Briefs: January 2021 #2

Health Care Compliance Association (HCCA) on

Report on Medicare Compliance 30, no. 2 (January 18, 2021) - Recovery audit contractors (RACs) may soon be auditing positron emission tomography (PET) for initial treatment strategy in oncologic conditions for compliance...more

Health Care Compliance Association (HCCA)

[Virtual Event] 2021 Regional Healthcare Compliance Conference - Portland, OR - February 5th, 8:25 am - 5:30 pm PST

Health Care Compliance Association (HCCA) on

Our Virtual Regional Healthcare Compliance Conferences provide updates on the latest news in regulatory requirement, compliance enforcement, and strategies to develop effective compliance programs. Watch, listen, and ask...more

Foley & Lardner LLP

Compliance: Top Takeaways from Foley and PYA’s Annual “Let’s Talk Compliance” Event

Foley & Lardner LLP on

For the second year in a row, Foley & Lardner LLP and PYA hosted a compliance master class on various health-related compliance issues. “Let’s Talk Compliance” is an annual one-day event featuring a panel of presenters that...more

Foley & Lardner LLP

AseraCare FCA Ruling Is A Boon For Health Providers

Foley & Lardner LLP on

All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more

Holland & Knight LLP

CMS Issues 2020 MPFS and QPP Final Rule

Holland & Knight LLP on

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

ArentFox Schiff

CMS Releases CY 2020 Proposed Physician Fee Schedule

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The Centers for Medicare and Medicaid Services (CMS) recently released the CY 2020 Proposed Physician Fee Schedule....more

Bass, Berry & Sims PLC

Healthcare Fraud & Abuse Review 2017

Bass, Berry & Sims PLC on

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Baker Donelson

Pathology Lab That Cannot Demonstrate Adequate Physician Orders Suffers Medicare Loss

Baker Donelson on

Much has been written regarding various Medicare policies that may cause a clinical laboratory to suffer the resulting financial consequences when a test requested by a physician is found to be not medically necessary, most...more

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