Health Populi

DECEMBER 4, 2019

With new rules emanating from the White House this month focusing on health care price transparency, health care costs are in the spotlight at the Centers for Medicare and Medicaid Services. The post Being Transparent About Healthcare Transparency – My Post on the Medecision Blog appeared first on HealthPopuli.com.

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The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] Indest III, J.D.,

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The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] Indest III, J.D.,

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MedTrainer

MAY 15, 2024

I can tell you from experience that managing medical credentialing services in New York is no different. Like I said, medical credentialing services in New York go the extra mile. 3. So be sure to allow time for that process when you are completing medical credentialing services in New York. Privileging.

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Innovaare Compliance

DECEMBER 11, 2023

Before the Medicare Advantage Open Enrollment Period (MA OEP) [1] begins on January 1, 2024, Medicare Advantage Organizations (MAOs) still have time to review if they are completely ready for a new contract year. This blog article focuses on some of the “must make” changes to take effect as of January 1, 2024, or before.

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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”). CMS will not apply a Fee-For-Service (“FFS”) Adjuster in RADV audits. See United States v.

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Health Law Attorney

DECEMBER 18, 2020

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Physician Fee Schedule ( PFS ) Final Rule. Since the beginning of the pandemic, CMS has added 144 telehealth services to the list of Medicare-covered services. The fact sheet may be accessed here. CMS’ action resulted in over 24.5

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The Health Law Firm Blog

MARCH 18, 2024

Department of Health and Human Services (DHHS) proposing to terminate you or exclude you from the Medicare Program? Indest III, J.D., Board Certified by The Florida Bar in Health Law Have you received a letter from the Office of the Inspector General (OIG) of the U.S. This is an extremely [.]

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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. 1395w-22(a) ). d)(2) ).

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Med Law Blog

FEBRUARY 8, 2024

Penn State Health has agreed to pay $11,712,336 to settle allegations of civil liability from submitting improper claims to Medicare for Annual Wellness Visit services. Once the improper claims were discovered, Penn State Health promptly took corrective action and disclosed the matter to the United States Attorney’s Office.

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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%.

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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.

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Hall Render

JULY 28, 2023

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”).

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Healthcare Law Blog

NOVEMBER 2, 2023

population size of those 65 years and older continues to increase, the demand for long-term services and supports (“LTSS”) is also expected to increase. [1] 1] LTSS represents the wide-ranging health and social services that individuals require over an extended period of time, including assistive services. [2]

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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.

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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”).

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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.

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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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The Health Law Firm Blog

JANUARY 8, 2024

Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. [.] Indest III, J.D.,

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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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NCG Medical Blog

SEPTEMBER 21, 2022

Don’t you love how easy it is to understand the Medicare billing process ? There are hardly any acronyms or complicated regulations; it’s a breeze!

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Healthcare It News

OCTOBER 31, 2022

"Our combined efforts are expected to demonstrate how best to advance our nation’s technical infrastructure to enable SDOH interoperability as supported by ONC’s United States Core Data for Interoperability (USCDI) Version 2," ONC authors Ryan Argentieri, Samantha Meklir and Jawanna Henry wrote in ONC's HealthITbuzz blog.

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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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Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025.

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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”). For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency.

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Provider Trust

MARCH 21, 2023

US Department of Health and Human Services (HHS) Office of Inspector General Christi A. 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.

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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%

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CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. keya.joy-bush@…. Fri, 11/02/2018 - 21:32.

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Health Law Advisor

AUGUST 14, 2023

During the COVID-19 PHE, CMS issued temporary waivers, including a waiver of the “location requirement” of the In-Office Ancillary Services (“IOAS”) exception. 1] With the end of the PHE having occurred over three months ago, that temporary waiver of sanctions ended and can no longer be relied upon for legal compliance with the Stark Law. [2]

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The Health Law Firm Blog

DECEMBER 23, 2023

Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). This agency investigates allegations of fraud, waste, and abuse against Medicare, Medicaid, and other federally funded healthcare programs. [.] Indest III, J.D.,

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The Health Law Firm Blog

JUNE 10, 2023

million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. Indest III, J.D., Board Certified by The Florida Bar in Health Law On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 The doctor argued that the [.]

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Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. Last month, the U.S. The OIG Report.

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Healthcare It News

OCTOBER 13, 2022

The new Microsoft Cloud for Healthcare tools have been designed to address provider burdens and facilitate proactive patient care, according to an October 12 Microsoft Health blog post by Tom McGuiness, corporate vice president of Microsoft's Worldwide Health. Data tools are also high on the list of provider IT needs for FHIR adoption.

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Medisys Compliance

JULY 25, 2023

Catch up on our blog series: Part 1 awaits your reading! Evaluation and management (E/M) services play a crucial role in the practice of internists, and accurate coding for these visits is essential for the financial well-being of medical practice. Coding Guidelines for Evaluation and Management Services in Internal Medicine 1.

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Healthcare Law Blog

JANUARY 17, 2024

23-15 ) (the “Opinion”) to a consulting vendor (the “Requestor”) that wanted to provide up to $75 in gift cards to physician practices in exchange for referring the Requestor’s practice optimization services (e.g., workflow and performance assessment, data analytics, and certain Medicare eligibility and performance assistance).

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The Health Law Firm Blog

MAY 8, 2023

Board Certified by The Florida Bar in Health Law Recently it has come to our attention that there may be a nationwide effort by the Centers for Medicare and Medicaid Services (CMS) Medicare Administrative Contractors (MACs) to squelch physicians who prescribe opioids [.] Indest III, J.D.,

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YouCompli

NOVEMBER 9, 2022

Compliant Billing for Critical Care Evaluation and Management Services. provides enforcement action summaries for the YouCompli blog. This month’s article looks at critical care services. million to settle allegations he violated the False Claims Act by submitting false claims that, in part, involved critical care services.

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