Med Law Blog

NOVEMBER 23, 2022

Please click the link to view the Medicare Physician Fee Schedule Final Rule Summary for 2023.

Medicare 52

Medicare Medicare 52

Med Law Blog

NOVEMBER 6, 2023

CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. of dollar and 15% (or 3.4%) from the 2023 conversion factor of $33.89. The final PFS conversion factor will be $32.74, which is a decrease of 1.15

Medicare 52

Medicare Medicare 52

Hall Render

DECEMBER 30, 2022

Medicare payment policy changes established under the CMS CY 2023 Medicare Physician Fee Schedule (“MPFS”) Final Rule , issued on November 1, 2022, become effective January 1, 2023. Below is a high-level summary of significant changes established for 2023. Evaluation and Management (E/M) Visits.

Medicare 40

Medicare Medicare Licensing Health Services Administration 40

Redox

DECEMBER 13, 2023

Learn more Remote patient monitoring RPM boosts outcomes but drives up costs In a new study, RPM reduced hospital stays among Medicare patients with hypertension but also raised costs per patient. The post Vital Lines November 2023 appeared first on Redox. Build an HL7 ® FHIR ® data store for your health system, minus the missteps.

Medicare 52

Medicare Medicare Hospitals 52

Redox

JULY 31, 2023

cut in physician fees The proposed Medicare Physician Fee Schedule for 2024 has landed, igniting backlash from many industry groups. Read more Information blockers face stiff penalties Certified health IT developers, HIEs, and HINs are subject to violation penalties starting on September 1, 2023. Top stories CMS proposes 3.4%

Telemedicine 52

Telemedicine Medicare Medicare Hospitals 52

Hall Render

MAY 23, 2023

The Centers for Medicare & Medicaid Services (“CMS”) is now accepting applications from ACOs to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) for the agreement period beginning January 1, 2024. Phase 1 of the application submission process opened May 18, 2023, and closes June 15, 2023.

Medicare 64

Medicare Medicare Medicaid Medicaid 64

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024. CMS anticipates the changes will increase MSSP participation by 10% to 20%.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

The Health Law Firm Blog

FEBRUARY 8, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

Healthcare Law Blog

FEBRUARY 28, 2023

On February 13, 2023, the Centers for Medicare and Medicaid Services (CMS) published the revised List of Telehealth Services for Calendar Year (CY) 2023 (List). The List includes the services that are payable under the Medicare Physician Fee Schedule when furnished via telehealth.

Medicare 52

Medicare Medicare Nurses Licensing 52

Provider Trust

APRIL 30, 2024

Though MFCUs reported a decrease in the volume of civil settlements and judgments in FY 2023, the amount of civil recoveries reached a four-year high. MFCUs reported 1,143 total convictions in FY 2023—a marked decrease from 1,327 convictions in FY 2022.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

The Health Law Firm Blog

JANUARY 18, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

Med Law Blog

JULY 17, 2023

The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75.

Medicare 52

Medicare Medicare 52

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

Medicare 40

Medicare Medicare Licensing Malpractice 40

Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

The Health Law Firm Blog

DECEMBER 28, 2023

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Fraud Governance 52

Verisys

JANUARY 2, 2024

The post December 2023 Bad Actors Roundup appeared first on Verisys. Million Civil Settlement with Total Access Urgent Care Over False Claims Allegations Full story Former Co-Owners of New Jersey Marketing Company Sentenced to Prison in $8.8 Million Compounded Prescription Drug Scheme Full Story Phillips Respironics Pays $2.4

Fraud 52

Fraud Licensing Doctors Medicare 52

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. This blog delves into the details of these changes and their implications for plan sponsors and beneficiaries. Are you prepared for the Medicare Part D changes in 2025?

Medicare 52

Medicare Medicare Compliance FDA 52

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. The Final Rule went into effect on June 5, 2023, and can be found here.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Healthcare Law Blog

AUGUST 11, 2023

On July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Physician Fee Schedule (“PFS”). CMS projects that the Proposed Rule will lead to growth in the Medicare Shared Savings Program (“MSSP”). on September 11, 2023.

Medicare 52

Medicare Medicare Nurses Medicaid 52

Health Law Advisor

AUGUST 14, 2023

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

Hall Render

JUNE 8, 2023

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

Medicare 40

Medicare Medicare Hospitals Governance 40

Healthcare Law Blog

MAY 22, 2023

With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% 1:1 education will include claim specific information and allow the SNF to review the claim decision, ask questions and receive feedback.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. Led by acting Inspector General Christi A.

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. This year, 50% of Medicare enrollees are expected to sign up for Medicare Advantage.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Healthcare Law Blog

NOVEMBER 9, 2023

On November 6, 2023, OIG finally published the GCPG on its website [3]. As illustrated in this blog post, GCPG is a valuable resource for both new and experienced professionals working both within and in support of organizations in the health care industry. 25000 (April 25, 2023). [2] FOOTNOTES [1] 88 Fed.

Compliance 52

Compliance Compliance Officers Fraud Medicare 52

Hall Render

MAY 16, 2023

Could it be that CMS is implementing changes in the Medicare Communications and Marketing standards that will change the content and tone of the omnipresent television and radio advertisements targeted at potential enrollees? Now, beginning July 10, 2023, any material or activity that is distributed by any means (e.g.,

Medicare 40

Medicare Medicare 40

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. Challenge in Court On September 1, 2023, Humana Inc. and its subsidiary Humana Benefit Plan of Texas, Inc.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

DECEMBER 27, 2023

The $5,000 limit is adjusted annually for inflation and will increase from the 2023 limit of $5,702 to $5,913 beginning January 1, 2024, for the 2024 calendar year. Hall Render blog posts and articles are intended for informational purposes only.

Hospitals 75

Hospitals Overpayments Overpayment Medicaid 75

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”).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Healthcare Law Blog

JANUARY 31, 2023

This blog is the second installment of our Digital Health Trends series. In November 2020, Oregon became the first state to legalize psilocybin-assisted therapy and began accepting applications for licensure on January 2, 2023. [v] v] “Oregon Psilocybin Services Overview,” Oregon Health Authority (accessed on January 31, 2023). [vi]

COVID-19 105

COVID-19 Medicare Medicare Medicaid 105

Health Populi

SEPTEMBER 27, 2023

health care’s negative-sum game, stakeholders who survive and win that game will have to deliver value-for-money, we learn from Trilliant Health’s 2023 Trends Shaping the Health Economy Report. health care financing. People are responding in ways they understand, trust, and I daresay… value.

COVID-19 96

COVID-19 Medical Billing Health Care Access Hospitals 96

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The Final Rule is effective June 5, 2023. Parts 417, 422, 423, 455, and 460. 79452 (2022)). 405.902).

Medicare 52

Medicare Medicare Overpayments Overpayment 52

McGuire Wood

SEPTEMBER 8, 2023

22, 2023, the Centers for Medicare & Medicaid Services (CMS) announced it was making unannounced site visits to every Medicare-enrolled hospice nationwide. The goal of the site visits was to ensure that each hospice was active and operational at the address listed on the Medicare enrollment forms.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Healthcare Law Blog

JANUARY 17, 2024

On December 28, 2023, the Office of Inspector General (the “OIG”) issued a favorable Advisory Opinion (No. workflow and performance assessment, data analytics, and certain Medicare eligibility and performance assistance). On December 28, 2023, the Office of Inspector General (the “OIG”) issued a favorable Advisory Opinion (No.

Medicare 52

Medicare Medicare Payment Systems Compliance 52

Healthcare Law Blog

NOVEMBER 1, 2022

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). See 42 U.S.C.

Medicare 52

Medicare Medicare COVID-19 Public Health 52