Health Care Law Brief

APRIL 12, 2023

Determinations of medical necessity will need to follow national coverage determinations, local coverage determinations, or, where none are applicable, plans must follow publicly available, evidence-based coverage criteria. If finalized, the amendments would have aligned the Medicare standard with the standard for liability under 31 U.S.C.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

YouCompli

DECEMBER 14, 2022

Here, any overpayment from a governmental payer source must be returned within 60 days of its identification. IT often recommends the adoption of certain tools and technologies that impact your electronic medical records. Those issues can help with early identification of localized and more systemic issues.

Compliance 52

Compliance Compliance Officers Nurses Overpayments 52

AIHC

APRIL 5, 2022

Providers may take documentation “short cuts” or feel overwhelmed with implementation of a new EMR (electronic medical record) system and clone or make documentation errors. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Compliance Medicare Medicare 52

Hall Render

OCTOBER 7, 2022

After court ruling for AHA in 340B case, HHS says it will start adjusting payment rates for certain 340B hospitals within approximately two weeks. Congress gives rural hospitals a reprieve, for now. Hospital leaders meet at White House to talk ‘twindemic’ strategies. Is the doctor’s office heading for extinction?

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40