Health Law Attorney

MARCH 2, 2022

The post Federal Court Strikes Down Portions of the No Surprises Act appeared first on Health Law Attorney Blog. Continue Reading ?.

Health Insurance 52

Health Insurance 52

Health Law RX

MARCH 21, 2023

We are not surprised by the continued stop-and-go regarding guidance surrounding the No Surprises Act. Most recently, a Texas court vacated portions of the No Surprises Act’s updated final rule (the final rules were discussed in our most recent blog on the subject).

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Hospitals Health Insurance 52

Health Care Law Brief

FEBRUARY 27, 2023

As discussed in a previous blog post , the QPA, [2] which is generally the median rate paid for the service by the payor in the community, was established as the presumptive appropriate amount in a final interim rule issued by the Departments in September 2021 based on the Departments stated goal of lowering health care costs.

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Hospitals 52

Hall Render

DECEMBER 5, 2022

Since January 1, 2022, the law has required providers and facilities to issue a GFE of expected charges to uninsured and self-pay individuals upon request or at the time of scheduling a health care item or service. Please see Hall Render’s prior Client Alert for a more detailed discussion of this GFE requirement.

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Medicaid Medicaid Medicare Medicare 72

Health Law Attorney

MAY 2, 2022

On April 22, 2022, the Department of Health and Human Services (“ HHS ”), in conjunction with several other federal agencies, filed a notice of appeal in opposition to a Texas federal judge’s summary judgment ruling regarding the No Surprises Act (“ NSA ”). In its February 2022 ruling, the U.S. Continue Reading ?.

Medical Billing 52

Medical Billing 52

Med Law Blog

AUGUST 9, 2023

CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows: UNPLANNED OUTAGE “On August 3, 2023, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. 149.510, 26 C.F.R.

Medical Billing 52

Medical Billing 52

AIHC

JANUARY 5, 2022

Written by: Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS As a result of the 2021 Consolidated Appropriations Act, several No Surprises Billing Act regulations went into effect on January 1, 2022, for providers, facilities and air ambulance services.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

Healthcare Law Blog

SEPTEMBER 6, 2023

The status of the independent dispute resolution (IDR) process under the No Surprises Act (NSA) is ever-evolving. Providers are waiting on the sidelines as cases weave their way through the court system. Where do things stand now and what can we expect in the future?

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Healthcare Law Blog

AUGUST 31, 2023

The Federal IDR and Patient-Provider Dispute Resolution processes remain suspended, and effective August 25, 2023, IDR entities have been directed to pause all IDR-related activities.

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Medicaid Medicaid Medicare Medicare 52

Bill of Health

MARCH 8, 2022

Federal disability law provides some guidance. A person who is high-risk for serious illness or death from COVID-19 is likely entitled to a reasonable accommodation under the Americans with Disabilities Act (ADA), including one that requires their co-workers to wear masks in their presence. By Katherine Macfarlane. It is false.

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ADA COVID-19 Public Health 364

Healthcare Law Blog

AUGUST 10, 2023

The court found that failure to afford stakeholders the opportunity to comment on the increase may have prejudiced healthcare providers by not affording them an opportunity to demonstrate that the fee increase could be cost prohibitive, among other things. The court vacated the Departments’ December 2022 guidance increasing the fee to $350.

Hospitals 52

Hospitals 52

Med Com Blog

DECEMBER 23, 2021

Starting January 1 st , 2022, healthcare consumers will find new protections in place against unexpected, out-of-pocket costs associated with surprise billing. Key patient protections , per the Journal of AHIMA, included in the interim final rule include: Banning surprise billing for emergency services.

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Medical Billing Compliance Hospitals 74

Health Law RX

SEPTEMBER 16, 2022

The Departments of the Treasury, Labor, and Health and Human Services (the Departments) issued final rules related to the No Surprises Act on August 26, 2022, to be effective October 25, 2022 ( Final Rules ). The information related to the offer provided in response to a request from the certified IDR entity.

Health Insurance 52

Health Insurance Hospitals 52

Health Law RX

MARCH 8, 2022

The No Surprises Act (the Act) continues to bump through its initial implementation phase. As we discussed in our prior blog , out-of-network physicians and facilities (OON Providers), and their allies, are pushing back against portions of the recently issued interim final rule with comment period (the Interim Rule ).

Health Insurance 52

Health Insurance Hospitals 52

Hall Render

NOVEMBER 3, 2022

Shortly thereafter, however, TMA filed a complaint with the Court arguing that the revised methodology in the Final Rule is also contrary to the language of the Act because it requires the IDR entity to give greater weight to the QPA as compared to any of the other statutory factors the IDR entity is required to consider in making its determination.

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Bill of Health

MARCH 21, 2023

This article will discuss the importance of the Americans with Disabilities Act (ADA) in protecting the rights of people with long COVID and other disabilities in the workplace, in health care, and in disability and other benefits in order to chart an equitable path forward. A 2022 report by the Brookings Institute estimates that of the 16.3

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Public Health COVID-19 ADA Health Insurance 238

Hall Render

AUGUST 31, 2022

Departments of Health and Human Services, Labor, and the Treasury (collectively, the “Departments”) published their first final rule (“Final Rule”) implementing certain requirements of the No Surprises Act. The requirements outlined under the Final Rule will go into effect on October 25, 2022. QPA Presumption Eliminated.

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Healthcare Law Today

JANUARY 20, 2022

This news comes as a relief to the provider community that has been working to understand the new notice and disclosure requirements that largely took effect simultaneously with the Federal No Surprises Act on January 1, 2022. Massachusetts similarly issued new requirements for providers under M.G.L.

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Patient Advocacy Nursing Homes Nurses Doctors 52

Health Populi

DECEMBER 28, 2021

.” As we enter Year 3 of the COVID-19 pandemic, social and civic chasms and economic uncertainty (inflation, health care costs, Great Resignations), I took this page out of Dr, Seuss in my last monthly post for Medecision’s Liberate Health blog. > consumers are “shrugging off” Omicron.

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COVID-19 COVID-19 Vaccine Doctors Health Care Access 165

YouCompli

JANUARY 4, 2022

Ross covered federal vaccine mandates, unwinding regulatory flexibilities, and Provider Relief Fund audits and enforcement. They provide great insight for Compliance practitioners. We provide a complete solution to help healthcare compliance organizations manage regulatory change. Her detailed slides are available from PYA here.

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Compliance Compliance Officers HIPAA Fraud 40

Hall Render

JANUARY 25, 2022

As of January 1, 2022, providers and facilities must comply with a number of requirements established by the No Surprises Act (the “Act”). Other aspects of the Act are not yet effective or are not currently being enforced. Other aspects of the Act are not yet effective or are not currently being enforced.

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Compliance 40

Health Law RX

OCTOBER 6, 2021

Efforts to stop surprise medical costs are continuing to evolve. The information in this blog is taken from the Interim Rule, unless otherwise noted. HHS understands it may take time for providers “to develop systems and processes for receiving and providing the required information” from co-providers.

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Health Insurance Hospitals 61

Healthcare Law Blog

FEBRUARY 24, 2023

6:22-cv-372 (TMA II) , which vacated specific rules governing the Federal IDR decision-making process for disputes related to OON providers, facilities and air ambulance providers. District Court for the Eastern District of Texas’ opinion on February 6, 2023, in the matter of Texas Medical Association, et al.

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Medicaid Medicaid Medicare Medicare 52

YouCompli

JUNE 29, 2022

Consolidated Appropriations Act . Not surprisingly, both government and health plan audits have identified what Compliance professionals warmly refer to as ‘opportunities’ with respect to how telehealth services are documented, coded, and reimbursed by healthcare providers.” . “Not the end of COVID-19. Interstate telemedicine.

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Compliance Officers Compliance Telemedicine Medicare 52

Health Law RX

JANUARY 27, 2022

Effective January 1, 2022, new billing protections went into effect that have the goal of providing greater protections for patients against surprise medical bills. This presumption is the basis of the controversy as the Out-Of-Network Providers deem a Plan’s median contracted rate to be an inappropriate starting point.

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Health Insurance Medical Billing Hospitals 52

Verisys

FEBRUARY 24, 2023

A Story About Provider Data, And Why It Has Become So Complex While leaving her house to visit her grandson, Sue falls and twists her knee. Many of Sue’s difficulties could have been avoided with current and correct provider data. A recent review found that over half of provider directories contain at least one error.

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Fraud Doctors Governance Licensing 52

Verisys

FEBRUARY 24, 2023

A Story About Provider Data, And Why It Has Become So Complex While leaving her house to visit her grandson, Sue falls and twists her knee. Many of Sue’s difficulties could have been avoided with current and correct provider data. A recent review found that over half of provider directories contain at least one error.

Fraud 52

Fraud Doctors Governance Licensing 52

MedTrainer

OCTOBER 29, 2023

California has the most rules of any state, so it’s no surprise that there is additional complexity when it comes to managing healthcare compliance in California. The Golden State also has a reputation for being at the forefront of healthcare policy innovation, which means that providers must constantly adapt to new laws and regulations.

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Compliance COVID-19 HIPAA Governance 52

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 This is the largest amount recovered under the False Claims Act since 2014. You may find this surprising, but as federal healthcare spending increases, so does the risk of abuse.

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Fraud Medicaid Medicaid Medicare 52

YouCompli

SEPTEMBER 20, 2023

I was a little surprised that he didn’t take the time to walk me over to the aisle to find it, because that was typical of my past customer experience. I was a little surprised that he didn’t take the time to walk me over to the aisle to find it, because that was typical of my past customer experience. So how do you do that?

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Compliance Compliance Officers Hospitals Governance 52

YouCompli

SEPTEMBER 15, 2022

Sharon Parsley, JD, MBA, CHC, CHRC, writes a monthly series on compliance officer effectiveness for the YouCompli blog. We have all had those hotline calls (typically occurring at 5:00 on Friday) where the reporter alleges a hostile work environment, provider misconduct, unethical billing practices, or discriminatory employment practices.

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Compliance Compliance Officers Hospitals 52

YouCompli

NOVEMBER 1, 2023

That person holds an entrance conference with the department director, and reviews the documentation against the regulatory requirements, but never communicates with the director about how they provide and document the service for billing purposes. Neutral intent means we don’t know whether a person acted with good or bad intent.

Compliance 52

Compliance US Department of Health and Human Services Compliance Officers Overpayments 52

Healthcare Law Blog

JANUARY 9, 2024

On the healthcare services side, NVIDIA mentioned GI Genius, which has an FDA approved AI-assisted endoscopy device that provides real-time identification and decision support to the provider conducting the endoscopy. Morgan Healthcare Conference, “[T]he answer to the ultimate question of life, the universe and everything is 42.”

Medicare 59

Medicare Medicare Hospitals Doctors 59

Medval Compliance Blog

MARCH 10, 2022

Rulemaking around Civil Money Penalties for Section 111 Reporting originally started after the SMART Act was passed in December 2013 with an Advanced Notice of Proposed Rulemaking (ANPRM). Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas.

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US Department of Health and Human Services Medicare Medicare Medicaid 52

Healthcare Law Blog

SEPTEMBER 22, 2022

In addition to adopting the Final Rule, CMS recently published a chart to assist providers and payers in determining whether the Federal IDR process is available in their respective states as well as guidance for parties submitting disputes to the Federal IDR process. District Court for the Eastern District of Texas. [ii]

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Medicaid Medicaid Medicare Medicare 52

YouCompli

AUGUST 2, 2022

Wolf, MD provides enforcement action summaries for the YouCompli blog. These summaries provide real-world examples of regulators’ response to practices that don’t fully comply with regulations. So, it should come as no surprise that we are seeing significant auditing and enforcement activity. Let’s look at a few.

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COVID-19 Vaccine COVID-19 Nursing Homes Compliance Officers 52

Hall Render

JULY 14, 2023

The PPS Rule usually only impacts the home health industry, but this year CMS has included proposals related to not only home health, but also hospice, DMEPOS and provider enrollment. Annual Home Health Payment Update For home health providers, the Annual Payment Update is the most anticipated and disappointing aspect of the PPS Rule.

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Medicare Medicare Payment Systems Governance 52