2011 and Medicare - Health Care Compliance Brief

Understanding the 2025 Medicare Part D Re-design: What You Need to Know

Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. Medicare Part D will have three (3) phases instead of four (4) – Deductible, Initial Coverage Phase and Catastrophic Phase. generics) in the catastrophic phase.

Medicare

Medicare Medicare Compliance FDA

Medicare Advantage RADV Audit Final Rule Challenged in Court

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. MAOs will be required to remit improper payments identified during RADV audits in a manner specified by CMS.

Medicare

Medicare Medicare Overpayments Overpayment

President Biden Signs End-of-Year Legislation Including Telehealth, Medicare & Medicaid, Mental Health, Pandemic Preparedness, and Other Health Care Provisions

C&M Health Law

JANUARY 25, 2023

For more information, or to better understand how the Act impacts your organization, please contact the professionals listed below, or your regular Crowell & Moring contact. Telehealth Section 4113 of the Act extends certain Medicare telehealth flexibilities that were allowed during the COVID-19 PHE for two years, through 2024.

Medicaid

Medicaid Medicaid Medicare Medicare

CMS’ Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Refining Definitions for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare

Medicare Medicare COVID-19 Medicaid

OIG’s Continued Focus on DRG Payment Window – Recommends Expanding Medicare 3-Day Payment Window to Cover Affiliated Entities

Hall Render

FEBRUARY 15, 2022

In December 2021, the Office of Inspector General (“OIG”) of the Department of Health and Human Services published an Issue Brief titled “Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than Wholly Owned Settings” (“Brief”)(available here ). Issue Brief Findings.

Medicare

Medicare Medicare Hospitals Compliance

CMS Publishes RADV Audit Methodology and Intent to Recover Overpayments

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. On January 31, 2023, CMS will begin releasing the results of RADV audits and overpayment demands for payment years 2011 through 2017.

Overpayments

Overpayments Overpayment Medicare Medicare

Reduced Co-Insurance for Screening Colonoscopies

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. These provisions are effective for services furnished on or after January 1, 2011. To know more about our billing and coding services, contact us at info@medisysdata.com/ 302-261- 9187. Background for Reduced Co-Insurance. Reference: [link].

Medical Billing

Medical Billing Medical Billing Outsourcing ACA Medicare

DOJ Withdraws Decades Old Antitrust Guidance as Scrutiny of Health Care Industry Continues

Hall Render

FEBRUARY 14, 2023

1, 1996); and Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (Oct. The three policy statements include, Department of Justice and FTC Antitrust Enforcement Policy Statements in the Health Care Area (Sept.

Hospitals

Hospitals Health Care Access Licensing Medicare

President Signs FY 2022 Funding Bill into Law with 340B, Telehealth and Other Health Care Provisions

Hall Render

MARCH 16, 2022

It’s also the first bicameral legislation to include community project funding (previously known as “earmarks”) since they were banned in 2011. Your primary Hall Render contact. Puerto Rico will receive an additional increase of $200 million if HHS certifies that its state Medicaid plan meets certain requirements.

COVID-19

COVID-19 Medicare Medicare FDA

Aspects of Social Determinants of Health: Collecting Data

Healthcare IT Today

OCTOBER 18, 2023

Data can be spotty, according to Eye, who says for instance that data from Centers for Medicare & Medicaid Services (CMS) often lacks racial identifications. Because of the time required to process SDoH, Eye says, institutions need to prioritize which patients to contact. The percentage is much higher in some areas.

Doctors

Doctors Public Health Medicare Medicare

October-December 2021 State Regulatory Developments

New Jersey Healthcare Blog

JANUARY 12, 2022

Exhibits can be reviewed by contacting the New Jersey Individual Health Coverage Program. Exhibits can be reviewed by contacting the New Jersey Small Employer Health Benefits Program. This includes agency name updates, contact information, and addresses. See adopted N.J.A.C. On October 4, 2021, at 53 N.J.R. See adopted N.J.A.C.

Licensing

Licensing Medicaid Medicaid Nurses

FDA Oversight of AI Software Developed by Health Care Providers

Health Law Advisor

AUGUST 10, 2023

According to the preamble to the 2011 Final Rule: A purchaser of an MDDS who has only used, configured, or modified the MDDS in accordance with the original manufacturer’s labeling, instructions for use, intended use, original design, and validation would not be considered a manufacturer for purposes of this regulation. 3] 21 U.S.C.

FDA

FDA Licensing Hospitals Medicaid

Ensuring Safety and Quality in America’s Nursing Homes

CMS.gov

APRIL 15, 2019

Administrator, Centers for Medicare & Medicaid Services. The SSAs visit and survey every Medicare and Medicaid participating nursing home in the nation at least annually to ensure they are meeting CMS’ health and safety requirements as well as state licensure requirements. Ensuring Safety and Quality in America’s Nursing Homes.

Nursing Homes

Nursing Homes Nurses Compliance Medicare

Health Care Compliance Brief

Understanding the 2025 Medicare Part D Re-design: What You Need to Know

Medicare Advantage RADV Audit Final Rule Challenged in Court

Trending Sources

President Biden Signs End-of-Year Legislation Including Telehealth, Medicare & Medicaid, Mental Health, Pandemic Preparedness, and Other Health Care Provisions

CMS’ Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs

OIG’s Continued Focus on DRG Payment Window – Recommends Expanding Medicare 3-Day Payment Window to Cover Affiliated Entities

CMS Publishes RADV Audit Methodology and Intent to Recover Overpayments

Reduced Co-Insurance for Screening Colonoscopies

DOJ Withdraws Decades Old Antitrust Guidance as Scrutiny of Health Care Industry Continues

President Signs FY 2022 Funding Bill into Law with 340B, Telehealth and Other Health Care Provisions

Aspects of Social Determinants of Health: Collecting Data

October-December 2021 State Regulatory Developments

FDA Oversight of AI Software Developed by Health Care Providers

Ensuring Safety and Quality in America’s Nursing Homes

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