Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. Characteristics of Prior Authorization Policies for New Drugs in Medicare Part D. 2023 Feb 23.

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Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). This option is available for five years and ends on March 31, 2027.

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Medicaid Medicaid ACA Public Health 52

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 52

Medicare Medicare Overpayments Overpayment 52

Healthcare Law Blog

FEBRUARY 22, 2023

The Rebate Programs are administered as part of the prescription drug affordability provisions of the Inflation Reduction Act (the “IRA”), which is aimed at “lower[ing] out-of-pocket drug costs for people with Medicare and improv[ing] the sustainability of the Medicare program for current and future generations.” [1]

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Medicare Medicare Medicaid Medicaid 52

HIT Consultant

MARCH 22, 2022

What You Should Know: – Cityblock Health, a value-based healthcare provider for Medicaid, dually-eligible and lower-income Medicare beneficiaries appoints co-founder Dr. Toyin Ajayi to CEO. Since launching in 2017, Cityblock has established itself as an industry leader in value-based care for marginalized populations.

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Healthcare Law Today

JANUARY 20, 2022

While the opioid crisis has been a declared public health emergency (PHE) since October 26, 2017, overdose deaths remain at an all-time high and have only been exacerbated by the COVID-19 pandemic. In the 12-month period starting in April 2021, over 100,000 people have died from drug overdoses, a 28.5% The New Rule and the SUPPORT Act.

Medicare 52

Medicare Medicare COVID-19 Public Health 52

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

Medicare 52

Medicare Medicare Overpayments Overpayment 52

AIHC

JANUARY 28, 2022

For more information on filing compliance cost reports, attend the Medicare Cost Report Camp in March 2022 presented by KraftCPAs and sponsored by the American Institute of Healthcare Compliance. This is calculated based on the hospital’s relative share of uncompensated care nationally. This is known as the hospital “market basket.”

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Medicare Medicare Hospitals Payment Systems 52

Healthcare IT Today

JUNE 21, 2023

Inflation will push Payers back into the Public Marketplace whether Statewide and Federal Health Exchanges, Medicaid and Medicare Before the pandemic, many payers left statewide health exchanges as they found more ways to become profitable outside of the public market. The past two years have seen the enrollment numbers surge to 14.5

Medicare 62

Medicare Medicare COVID-19 Medicaid 62

The Health Law Firm

AUGUST 14, 2017

Board Certified by The Florida Bar in Health Law On August 3, 2017, the Centers for Medicare & Medicaid Services (CMS) approved a five-year extension of Florida’s Managed Medical Assistance (MMA) section 1115 demonstration. Tools For More Effective Medicaid Programs. Indest III, J.D.,

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Medicaid Medicaid Medicare Medicare 40

Hall Render

JANUARY 24, 2024

CMS introduced an updated Medicare Cost Report e-Filing system (“MCReF”) and related templates to allow Medicare Part A providers the ability to electronically file to their Medicare contractor supporting documentation in addition to their cost report for fiscal years ending on or after December 31, 2017.

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Medicare Medicare Medicaid Medicaid 40

HIT Consultant

OCTOBER 31, 2023

What You Shoud Know: – Medicaid prospective payment rate for Michigan’s federally qualified health centers (FQHCs) has not kept pace with the actual costs incurred to provide healthcare, resulting in a substantial reimbursement gap of $97.95 and indirect costs rising by 26.2%.

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Medicaid Medicaid Medicare Medicare 52

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

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Nursing Homes Medicaid Medicaid Medicare 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”).

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Medicare Medicare Medicaid Medicaid 52

HIT Consultant

NOVEMBER 4, 2021

– Since its 2017 founding, Papa and its Papa Pals have served members in all 50 states, across Medicare Advantage, Medicaid, and employer health plans.

Health Outcomes 97

Health Outcomes Medicaid Medicaid Medicare 97

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

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Fraud Medicaid Medicaid Doctors 95

HIT Consultant

FEBRUARY 15, 2022

billion in 2017, is projected to reach more than $8.5 Given CMS’ recent decision to double the weight of experience-based quality measures used to calculate Medicare Advantage Star Ratings, harnessing the power of these two types of analytics applications together could become a key determinant of success in 2022 and beyond.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

C&M Health Law

MAY 11, 2022

Last week, the Centers for Medicare & Medicaid Services (CMS) released data —for the first time—reporting on mergers, acquisitions, consolidations, and changes of ownership of Medicare enrolled hospitals and nursing homes over the past six years.

Nursing Homes 52

Nursing Homes Nurses Medicaid Medicaid 52

The Health Law Firm

MARCH 8, 2016

Board Certified by The Florida Bar in Health Law On February 26, 2016, The Centers for Medicare & Medicaid Services (CMS) extended the deadline for eligible hospitals/professionals and critical access hospitals to apply for a hardship exception from the 2015 Medicare Electronic Health Records Incentive Program.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

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US Department of Health and Human Services Medicare Medicare Overpayments 59

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients. By George F. Indest III, J.D.,

Fraud 40

Fraud Medicare Medicare Governance 40

HIT Consultant

JUNE 22, 2022

billion in 2017 – a number that has only risen since the onset of COVID-19. In 2019 alone, and under the traditional fee-for-service model, Medicare spending on skilled nursing facilities (SNFs) averaged $27.8 The differences in Medicare payments to care settings are also significant.

Hospitals 98

Hospitals Medicare Medicare COVID-19 98

Natalia Mazina

AUGUST 6, 2022

This allegedly fraudulent scheme resulted in the submission of false claims to federal health care programs, including Medicare and Medicaid. More information on the case: United States et al. Habana Hospital Pharmacy, Inc. 17-CV-80871-KAM, S.D.Fla.,

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Governance Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

MAY 9, 2022

million to the United States government to settle claims of improperly billing the Medicare Program for home health services provided to beneficiaries living in Florida. Juan Antonio Gonzalez, US Attorney for the Southern District of Florida, stated, “The fraudulent billing of Medicare will not be tolerated.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Compliance 59

Med-Net Compliance

AUGUST 18, 2022

to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. The complaint alleged that the provider had engaged in conduct to defraud the Medicare program. Based on the investigation, the estimated loss to the Medicare program was $2,795,522.33. to the United States.

Nursing Homes 59

Nursing Homes US Department of Health and Human Services Nurses Medicare 59

Med-Net Compliance

JUNE 15, 2022

California Attorney General Rob Bonta announced a settlement against a Southern California doctor for submitting false claims to Medicare and Medi-Cal between the years of 2011 and 2018 for drugs, procedures, services, and tests that were never administered to patients. in October 2017?under The doctor?is?an The case was ?

Fraud 59

Fraud Doctors Elder Abuse Medicare 59

HIT Consultant

FEBRUARY 1, 2023

What You Should Know: – Based on prevalence estimates from PINC AI™ data during 2017-2022, an estimated 66 million emergency department (ED) outpatient visits and 760,000 inpatient admissions in the U.S. during 2017-2022, creating a substantial economic burden for affected hospitals. – Patients with an OUD diagnosis had 32.5

Hospitals 52

Hospitals Medicaid Medicaid Health Outcomes 52

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

The Health Law Firm

MARCH 6, 2017

The Health Law Firm On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in the Medicare and Medicaid. By Michelle Bedoya, J.D., Patient Centered Process.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

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.

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Overpayments Overpayment Medicare Medicare 40

MedTrainer

MARCH 3, 2021

The Physician Quality Reporting System (PQRS) was first introduced over a decade ago by the Centers for Medicare and Medicaid Services (CMS) as a quality reporting program. Eligible professionals (EP) also received this downward payment adjustment in 2017. Information is also available from your local Medicare carrier.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

DECEMBER 20, 2021

The Partners, complemented by a team of private equity professionals, have successfully invested together since 2017, with approximately $700 million of funds committed and a track record of 11 portfolio companies.

ACA 52

ACA Medicaid Medicaid Medicare 52

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. 2018 Medicare Fee-For-Service improper payment rate is lowest since 2010 Significant progress in saving $4.59B in estimated improper payments for the Medicare Fee-For-Service program.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Health Populi

FEBRUARY 14, 2018

Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. per year, 2017-26, expected to hit $5.7 The annual growth rate of medical spending will be 5.5%

Health Insurance 79

Health Insurance Medicare Medicare Medicaid 79

HIT Consultant

AUGUST 17, 2021

In 2018, 36% of spending was via alternative payment models and by 2025, CMS has targeted 100% of Medicare and 50% of Commercial and Medicaid spending.4 Founded in 2017, ClosedLoop’s healthcare data science platform is purpose-built and dedicated to healthcare.

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COVID-19 Health Outcomes Medicaid Medicaid 98

Healthcare Law Blog

MARCH 25, 2022

Then, in July 2018, HHS announced it would republish the previously adopted risk-adjustment rule for the 2017 benefit year. More specifically, for 2017, Vista Health ’s first full year of business, HHS assessed risk-adjustment charges of over $4.3 And for the 2018 benefit year, HHS promulgated a new rule in December 2018.

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ACA US Department of Health and Human Services Health Insurance Medicaid 52