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”).

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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.

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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.

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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? Hall Render blog posts and articles are intended for informational purposes only.

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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. Hall Render blog posts and articles are intended for informational purposes only.

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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.

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Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. General Legal Duties and Antitrust Laws.

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MedTrainer

JUNE 15, 2022

This is the case for proposed changes to the Medicare Shared Savings Program, as they’ll impact ACOs in more ways than one if they’re enacted. Before we discuss the proposed changes to the Medicare Shared Savings Program, let’s take a moment to review ACOs. What Are the Changes to the Medicare Shared Savings Program?

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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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Hall Render

OCTOBER 27, 2023

According to a recent study , physician-owned hospitals treated some of the most expensive Medicare beneficiaries at significantly lower costs compared to traditional hospitals, despite serving similar patient populations. Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

FEBRUARY 21, 2023

For SNFs, the 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. Hall Render blog posts and articles are intended for informational purposes only.

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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. These services will be reported with three separate Medicare-specific G codes. Evaluation and Management (E/M) Visits. Split/Shared E/M Visits.

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Hall Render

JANUARY 20, 2023

Kaiser Family Foundation released a report answering FAQs on Medicare coverage for mental health and substance use disorder. The FAQ outlines which services are covered by Medicare in the wake of the Consolidated Appropriations Act of 2023 and the 2023 Medicare Physician Fee Schedule Final Rule.

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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]

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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.

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Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”). Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

FEBRUARY 23, 2024

Health Care Fraud Actions Medicare Advantage. As the largest component of Medicare, Medicare Advantage (Medicare Part C) was a target in 2023. Another Medicare Advantage plan provider agreed to pay $22.5 Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

APRIL 4, 2024

The Requestor’s services further include offering physician practices training related to the Medicare Merit-Based Incentive Payment System (“MIPS”), which could result in higher Medicare reimbursement to the Requestor’s clients. Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Hospitals and stakeholders should review whether they are in a county affected by the updated delineations and assess any potential impact on Medicare reimbursements.

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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.

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Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

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Hall Render

JULY 18, 2023

Over the last 12 months, the Centers for Medicare & Medicaid Services (“CMS”) has received many  reports  of hospice fraud. Hall Render blog posts and articles are intended for informational purposes only. Submitting a change of ownership that meets all the regulatory requirements under 42 CFR 489.18.

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Kaiser Health News

APRIL 4, 2024

Meanwhile, President Joe Biden, gearing up for the general election campaign, is highlighting his administration’s health accomplishments, including drug price negotiations for Medicare. Lauren Weber: The Washington Post’s “ Bird Flu Detected in Dairy Worker Who Had Contact With Infected Cattle in Texas ,” by Lena H.

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Hall Render

JULY 27, 2023

As part of this release, CMS identified groups of Medicare-certified nursing homes linked together by common owners and operators, referred to as “affiliated entities.” Hall Render blog posts and articles are intended for informational purposes only.

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Health Law Advisor

SEPTEMBER 1, 2023

On August 29, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the ten (10) Medicare Part D drugs selected for the first round of negotiations of the Medicare Drug Price Negotiation Program (Program)—a few days before the September 1, 2023, statutory deadline imposed by the Inflation Reduction Act (IRA).

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Hall Render

JULY 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. Hall Render blog posts and articles are intended for informational purposes only.

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Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

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AIHC

AUGUST 30, 2023

Is your engagement with the telemarketing firm include providing that firm with patient names and contact information? We couldn’t talk about websites without mentioning “Blogs”. Blogs can be used for various purposes which can be a great way for sharing information. The key to blogs is you do have to keep them updated.

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MRO Compliance

JUNE 1, 2022

HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Depending on the score of a health plan, payers may receive considerable Medicare financial incentives if a score exceeds a certain level. HEDIS audits are important for Medicare and Medicaid health plans.

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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”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

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Hall Render

JULY 25, 2023

A new mandatory bundled payment model is likely on its way in 2026, and the Center for Medicare & Medicaid Innovation (“CMMI”) is seeking input on how to structure the model to work for existing population-based models, including accountable care organizations (“ACOs”).

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MedTrainer

MARCH 28, 2024

In this blog, we’ll outline the many roles that impact healthcare compliance , the pros and cons of each role’s management responsibilities, and what each is accountable for in concert with the others. But that’s only one aspect of this complex – and sometimes confusing – process.

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Hall Render

MARCH 20, 2024

The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive Payment System.

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MedTrainer

MAY 15, 2024

The state requires a process similar to Medicare , which includes obtaining DMEPOS accreditation from a CMS-approved organization, enrolling in Medicare, and posting a surety bond to the enrollment contractor. Ensure the provider’s CAQH profile is up to date and set up a PECOS portal if the provider will be enrolling with Medicare.

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Hall Render

FEBRUARY 9, 2024

For more information contact Dusty Greer at dgreer@hallrender.com. Additionally, there has been an increase in patients with Medicare/Medicaid presenting to EDs, while those with private insurance are declining. Hall Render blog posts and articles are intended for informational purposes only.

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Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. Your primary Hall Render contact. Hall Render blog posts and articles are intended for informational purposes only.

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MedTrainer

FEBRUARY 29, 2024

In this blog, we’ll describe near-miss events and how incident reporting software helps healthcare organizations better understand causes and ways to prevent future problems. Contact us to learn more. It’s not uncommon to read about an asteroid that passed Earth in what scientists call a “near miss.” What is a Near-Miss Event?

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