News & Analysis as of

Reimbursements

Woodruff Sawyer

When Doctors Disappear: Addressing the Human Cost of a Strained Workers’ Comp System

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In the last few years, there has been a growing shortage of physicians to treat workers’ compensation cases across the country. Employees who are injured on the job are finding it increasingly difficult to access timely and...more

Health Care Compliance Association (HCCA)

UPICs May Audit Skin Substitutes Twice; Are Lawsuits Against Manufacturers Coming?

As the audits and investigations of wound care procedures with skin substitutes march on, providers who were audited once by a CMS unified program integrity contractor (UPIC) should prepare for a second round. And if the UPIC...more

Bricker Graydon LLP

Ohio Supreme Court Win for Nursing Homes and Quality Incentive Payments

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In a unanimous decision on September 2, 2025, the Ohio Supreme Court delivered a major win to nursing home operators by ordering the Ohio Department of Medicaid (ODM) to recalculate the quality incentive payments for nursing...more

Polsinelli

Colorado Budget Cuts Hit Home for Medicaid Providers

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Key Takeaways - Colorado’s new budget law and executive order impose immediate Medicaid reimbursement cuts and reinstate prior authorization and claim review requirements....more

American Conference Institute (ACI)

[Virtual Conference] 6th Annual Passport to Proficiency on Rx Drug Pricing & Rebate Fundamentals - November 4th - December 4th,...

ACI's virtual 6th Annual Passport to Proficiency on Rx Drug Pricing & Rebate Fundamentals will help you master the fundamentals, comprehend the consequences of new developments, and prepare for the complexities and nuances of...more

PilieroMazza PLLC

[Webinar] Overcoming the Compliance Minefield of Cost-Reimbursement Contracts, Part 1: Preparing for a Surge in DCAA Audit...

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With audit activity from the Defense Contract Audit Agency (DCAA) on the rise, government contractors—especially small and mid-sized businesses—must be prepared for increased scrutiny. In Part 1 of this 3-part webinar series,...more

BakerHostetler

Millions of Dollars Paid by Major Hospital Operator Due to Alleged Unlawful Training Repayment Agreements

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A major U.S. hospital operator recently agreed to pay approximately $3.5 million to settle claims that it unlawfully trapped nurses in agreements requiring them to repay their employers for job-related training costs if they...more

Pillsbury - Bid Protest Debrief

Protester Gets Paid: GAO Finds Army Waited Too Long to Fix Flawed Award

After the GAO indicated it would likely sustain Perimeter Security Partners’ protest challenging a task order award for access control point maintenance, the Army took corrective action—but only after filing its agency report...more

Hogan Lovells

Payments: European Court of Justice (ECJ) rules on PSP liability for unauthorised transactions and late PSU notification

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The ECJ has confirmed that a payment service user (PSU) is deprived of the right to reimbursement for an unauthorised transaction under PSD1 if: they fail to notify without undue delay upon becoming aware of it; or...more

McGuireWoods LLP

From Delivery to Recovery: Unlocking Value in Postpartum Health

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Most maternal health complications happen after delivery, but for decades, postpartum care remained one of medicine’s most neglected phases of life. That is changing fast. The first 12 weeks after delivery, long overlooked,...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - October 6th - 9th, San Antonio, TX

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

Gardner Law

NTAP: How to Secure Supplemental Medicare Reimbursement in FY2027

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The New Technology Add-On Payment (NTAP) program remains one of the most powerful and underutilized tools for securing Medicare reimbursement for novel medical technologies. For eligible products, NTAP provides additional...more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - August 2025 #3

News Briefs - Physician Productivity Rising, But Reimbursement Isn't -Physicians are working more than ever, but reimbursement isn't rising in tandem. It's a worrying mismatch that could translate into access problems for...more

ArentFox Schiff

Federal Court Finds Provider/Payer Medicare Advantage Agreements Do Not Implicate Federal Question Jurisdiction

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A North Carolina federal court’s recent order granting remand in the case Nash Hospitals, Inc. v. UnitedHealthcare of North Carolina, Inc., et al., No. 5:25-CV-28-FL underscores the limits of federal question jurisdiction in...more

McGuireWoods LLP

CMS Proposes Reimbursement Changes for Remote Patient Monitoring

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On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (PFS Proposed Rule). The PFS Proposed Rule proposes to reduce requirements for several...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - September 8th - 11th, Scottsdale, AZ

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

Davis Wright Tremaine LLP

The Two-Midnight Rule as a Sword but Not a Shield?

For over a decade, the two-midnight rule has served as an important determinant of whether a hospital inpatient stay is reimbursable by Medicare, as well as a measure of protection for hospitals that treat patients over...more

McDermott Will & Schulte

Key takeaways | Navigating financial distress: Strategies for hospitals and health systems

Hospitals and health systems are facing significant financial and operational challenges, including inadequate reimbursements, rising labor costs, and regulatory and economic uncertainties. These hurdles, coupled with the One...more

McDermott Will & Schulte

HRSA issues 340B rebate model pilot program guidance, requests comments

The Health Resources and Services Administration (HRSA) issued a notice announcing the application process for the 340B rebate model pilot program and requesting public comment. The notice sets the parameters of 340B rebate...more

Kohrman Jackson & Krantz LLP

Why More Employers Are Turning to ICHRA for Affordable Health Care Benefits

Many employers have faced the same “knot in the stomach” moment during insurance renewal season. We’re all too familiar with the stress of inexplicably rising health care costs, especially when group plan risk pools take an...more

Benesch

Benesch Healthcare+ Fifth Annual Nephrology and Dialysis Conference | Thought Leader Wrap-Up 2025

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Dr. Keith Bellovich delivered a fast-paced and highly relevant overview of the federal policy and legislative environment impacting kidney care. The session covered economic realities, legislative gridlock, CMMI model...more

Dickinson Wright

Telehealth Summer 2025: Collaboration Models, Enforcement Trends, and Reimbursement Guidance

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It has been a busy summer for telehealth updates. Following is a high-level summary of the latest developments. On June 6, 2025, the Office of Inspector General of the U.S. Department of Health and Human Services (the “OIG”)...more

King & Spalding

CMS Issues Final Rule for Updates to Medicare Payment Rates for Skilled Nursing Facilities Under the Skilled Nursing Facility...

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On August 4, 2025, CMS issued a final rule (Final Rule) updating payment rates, policies, and quality programs for Skilled Nursing Facilities (SNFs) under the Medicare Prospective Payment System (SNF PPS) for Fiscal Year (FY)...more

Stotler Hayes Group, LLC

Long-Term Care Insurance and Medicaid

The demographic shift toward an aging population has thrust the coordination of long-term care insurance and Medicaid benefits into the spotlight of elder law practice. For practitioners advising individuals on long-term care...more

Pullman & Comley - Connecticut Health Law

New Billing Codes for At-Home Acute Kidney Injury Renal Dialysis

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) confirmed that, effective January 1, 2025, CMS will pay for acute kidney injury (AKI) renal dialysis treatments at-home at the daily rate based on...more

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