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Reimbursements Healthcare Health Care Providers

Ropes & Gray LLP

Hospital and Health Systems Reimbursement Check July 2025

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In the early days of the second Trump Administration, several federal funding agencies announced caps to indirect cost (“IDC”) rates for federally funded research awards. In many cases, these caps would substantially reduce...more

DLA Piper

Proposed CY 2026 Medicare Physician Fee Schedule Rule Signals Support for Digital Health Advancement

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On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule (Proposed Rule). This client alert focuses on the proposed...more

Proskauer - Health Care Law Brief

Disproportionate Impact: Supreme Court Narrows Disproportionate Share Hospital Reimbursement to Supplemental Security Income Cash...

The U.S. Supreme Court has issued a significant ruling affecting hospitals that serve low-income Medicare beneficiaries, narrowing the interpretation of the Disproportionate Share Hospital (“DSH”) payment formula. In...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

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Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

J.S. Held

Inside the Healthcare Industry: The Critical Role of Medical Coding, Billing & Nurse Review

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In what is already a highly regulated industry, it is becoming increasingly difficult for healthcare organizations to navigate the growing volume, complexity and enforcement of laws, regulations and guidance that surround...more

McDermott Will & Emery

Trending in Telehealth: February 2025

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Trending in Telehealth highlights monthly state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and...more

Fox Rothschild LLP

Trump Administration’s Proposed Health Care Cuts Pose Risks to Distressed Providers

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Last week, the Trump administration and Congress proposed spending cuts that if enacted are likely to affect federally funded health insurance programs such as Medicaid and the Affordable Care Act (ACA). These cuts could...more

Kerr Russell

The Difference Between ‘Non-Covered’ vs. ‘Disallowed’ Services

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Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more

Lowenstein Sandler LLP

Virginia Hospital Indicted for Allegedly Turning a Blind Eye to Doctor’s Crimes

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In an unusual criminal prosecution, the Chesapeake Regional Medical Center (CRMC), a hospital in Chesapeake, Virginia, was indicted last week by a federal grand jury in Virginia for conspiring to defraud the United States and...more

Stikeman Elliott LLP

Federal Government Announces Policy on Canada Health Act Status of Payments to Regulated Healthcare Professionals Providing...

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Friday, the Federal Government issued correspondence to the provinces and territories regarding its newly introduced Canada Health Act Services Policy. As set out in this correspondence from the Minister of Health, the CHA...more

Whiteford

Client Alert: Phoning It In: Congress Passes A Short Extension To Medicare Telehealth Flexibilities As 2025 Approaches

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With the end of 2024 and an expiration of applicable Medicare telehealth flexibilities approaching, Congress passed the American Relief Act of 2025, preserving applicable flexibilities for an additional three months, through...more

Baker Donelson

2025 Medicare Physician Fee Schedule: Payment and Overpayment Policies

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On December 9, 2024, the Centers for Medicare & Medicaid Services' (CMS's) Calendar Year 2025 Physician Fee Schedule Final Rule (the Final Rule) was published in the Federal Register. The Final Rule includes noteworthy...more

Ankura

The Impact of the Proposed 2025 Physician Fee Schedule on Parity and Delivery

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Healthcare in the United States is undergoing significant changes, particularly in the areas of reimbursement and coverage of telehealth, substance use disorders (SUDs), and mental health services. The proposed 2025 Physician...more

Nelson Mullins Riley & Scarborough LLP

Federal Regulatory Update: CMS Medicare Payment Changes & Congressional Next Steps

The Centers for Medicare & Medicaid Services (CMS) have released significant updates affecting Medicare payments for 2025. The changes, outlined in two final rules, will impact both physicians and hospitals, eliciting strong...more

Ropes & Gray LLP

Hospital and Health Systems Reimbursement Check - NOVEMBER 2024

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Ropes & Gray attorneys share their analysis of administrative and court litigation, regulatory developments, key developments affecting federal program payments to hospitals and health systems, and other reimbursement-related...more

Zuckerman Spaeder LLP

A Pivotal Moment in the Fight for Behavioral Health Equity: New Parity Regulations and More

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The NAADAC 2024 Conference & Hill Day is an annual conference that brings together thousands of addiction counselors, educators, and other addiction-focused health care professionals from across the country. The conference...more

McDermott Will & Emery

Trending in Telehealth: September 17 – 30, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate...more

Foley & Lardner LLP

Artificial Intelligence in Health Care: Key Considerations for Oncology

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Artificial intelligence (AI) has the power to revolutionize health care. In oncology, there are now opportunities to apply AI to support diagnostics, predictive analytics, and administrative functions. This hot topic was...more

McDermott Will & Emery

Trending in Telehealth: August 26 – September 17, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate...more

Saul Ewing LLP

Pennsylvania Expands Use and Reimbursement of Telemedicine and Bans Noncompete Agreements for Certain Health Care Practitioners

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In July 2024, Pennsylvania enacted two significant pieces of legislation relating to telemedicine and physician noncompetition agreements that will have a meaningful impact within the healthcare delivery system with the...more

McDermott Will & Emery

Trending in Telehealth: July 9 – 15, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

McCarter & English, LLP

New Jersey Statutory Update Part II

Below is Part II of our New Jersey Statutory update. As you can see from the below, several statutes were passed imposing requirements on health insurance payers, including new requirements for prior authorization request and...more

McDermott Will & Emery

Trending in Telehealth: May 14 – May 20, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

McDermott Will & Emery

Trending in Telehealth: May 7 – May 13, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

Ankura

What Is the Role of the Health System in Addressing the Behavioral Health Epidemic?

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One in five U.S. adults experienced mental illness in 2021. This represents 57.8 million people. However, only 47.2% of U.S. adults with mental illness received treatment in 2021. The country is deep in a behavioral health...more

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