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”). case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. See also Ratanasen v.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

YouCompli

FEBRUARY 22, 2023

Price increases can sometimes result in inappropriate outlier payments. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS states a temporary adjustment is necessary to offset this overpayment.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40