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Showing 57 posts in Centers for Medicare & Medicaid Services (“CMS”).

OIG and CMS Audits Present New Round of Compliance Concerns for Healthcare Providers

By Lisa English Hinkle on February 23, 2022
Posted In Audit, Centers for Medicare & Medicaid Services (“CMS”), COVID-19, Office of Inspector General of the United States Department of Health and Human Services (OIG)

Since the beginning of the Public Health Emergency, Centers for Medicare and Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) data reflect over 44 million COVID-19 cases, 3 million COVID-19 related hospitalizations, and 720,000 COVID-19 deaths. COVID-19 has placed enormous stress on our healthcare system. Federal and state responses to COVID-19 have woven a complex and complicated safety net by easing regulatory requirements through waivers and funneling billions of dollars to providers among many other actions.  Just as the pandemic may finally be easing, federal focus on use of COVID-19 resources promises to increase healthcare providers’ stress.  More >

Tags: Audit, Centers for Medicare & Medicaid Services, CMS, COVID-19, Healthcare Compliance Issues, Medicaid, Medicare, regulatory compliance

Vaccination Mandate for Healthcare Facilities Blocked by Federal Court

By Anne-Tyler Morgan on December 6, 2021
Posted In Centers for Medicare & Medicaid Services (“CMS”), Hospitals, Mandatory vaccination policies

The Centers for Medicare and Medicaid Services (CMS) Interim Final Rule which would have required COVID-19 vaccination for employees of healthcare facilities that receive Medicare and/or Medicaid funding has been blocked by a federal court in Louisiana. Here’s what healthcare employers need to know. More >

Tags: CMS, coronavirus, COVID-19, Healthcare Organizations, Healthcare Provider, Healthcare Providers, hospitals, Mandatory vaccination

Policy Reversal Means Return of Per Day Fines for Nursing Homes

By Lisa English Hinkle, Ed Monarch on October 18, 2021
Posted In Centers for Medicare & Medicaid Services (“CMS”), Long-term care communities, Long-Term Care Providers ("LTC"), Skilled Nursing Facilities (“SNFs”)

On July 19, 2021, the Center for Medicare and Medicaid Services (“CMS”) rescinded a guidance issued in 2017 that significantly limited the discretion of CMS Locations to impose substantial fines for noncompliance. (For reference, the 2017 Guidance can be found here. The accompanying CMP Analytic Tool can be found here.)  More >

Tags: Centers for Medicare & Medicaid Services, Civil Penalties, CMS, Healthcare Providers, Long-Term Care, Long-Term Care Facilities, Medicare

Healthcare Providers Take Notice: AMA Updates E/M Codes for 2021

By Lisa English Hinkle on April 16, 2021
Posted In Centers for Medicare & Medicaid Services (“CMS”), Code Enforcement, Medicare

In addition to staying up to date on the constantly changing landscape of COVID-19 requirements, healthcare providers must also stay well-informed of industry changes unrelated to the pandemic. On January 1, 2021, changes in Evaluation and Management (‘E/M’) codes for physicians took effect. These changes, proposed by the Centers for Medicare & Medicaid Services (‘CMS’), primarily impact 2021 Medicare Physician Fee Schedule (‘MPFS’) reimbursements. More >

Tags: Centers for Medicare & Medicaid Services, CMS, E/M codes, Healthcare Compliance Issues, Healthcare Organizations, Healthcare Providers, Medicare, reimbursement rates

CMS Suspends the Advance Payment Program and Reevaluates Accelerated Payments

By Lisa English Hinkle on April 28, 2020
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law

On April 26, 2020, the Centers for Medicaid & Medicare Services (CMS), announced that the Advance Payment Program for Part B suppliers was ending immediately and that the amounts being paid under the Accelerated Payment Program will be reevaluated. Going forward, new applications for the Advanced Payment program will not be accepted.  There are interesting implications and questions for providers who received funds under this program going forward as CMS has not issued any guidance concerning how this will be handled. More >

Tags: Centers for Medicare & Medicaid Services, CMS, coronavirus, Coronavirus Aid, Relief and Economic Security Act, COVID-19, Health Care Enhancement Act, Paycheck Protection, Paycheck Protection Program

Coronavirus: Section 1135 Waivers Bring Relief to Healthcare Providers

By Lisa English Hinkle on March 19, 2020
Posted In Centers for Medicare & Medicaid Services (“CMS”), Department of Medicaid Services’ (“DMS”), Kentucky’s Department for Medicaid Services, Medicaid, Medicare

Invoking powers under the National Emergency Act and the Stafford Act on March 13, 2020, the President declared a national emergency, which, in turn, authorized the Secretary of Health and Human Services to waive conditions of participation requirements for payment for healthcare providers through waivers provided under Section 1135 of the Social Security Act.  The 1135 waivers do not replace 1115 waivers that require states to individually submit requests for waiver of selected Medicaid requirements, but the 1135 waivers are designed to temporarily give healthcare providers more flexibility in providing services during the pandemic crisis. The 1135 waiver is very helpful but does not address all situations or answer all questions, and it creates ambiguity in certain circumstances.   More >

Tags: Centers for Medicare & Medicaid Services, CMS, hospitals, Kentucky Medicaid, Medicaid, Medicare, Nursing Facilities, Section 1135, skilled nursing facilities, Waivers

A New Opportunity: Centers for Medicare and Medicaid Services Recognizes the Full Potential of Ambulance Crews and Services

March 26, 2019
Posted In Centers for Medicare & Medicaid Services (“CMS”), Department of Health and Human Services (HHS), Health Care Law

In mid-February 2019, the Centers for Medicare and Medicaid Services (“CMS”), Innovation Center and the Department for Health and Human Services (“HHS”) announced a ground-breaking payment and medical services initiative for ambulance providers called “Emergency Triage, Treat and Transport” (the “ET3”). This new model is the first step in allowing providers of Emergency Medical Services to finally “take off the gloves” to fully utilize both their medical skills and unique patient knowledge to implement a more efficient and effective care model. More >

Tags: Centers for Medicare & Medicaid Services, Department of Health & Human Services (“HHS”), Emergency Medical Services, Emergency Triage, Treat and Transport (ET3), Medicaid, Medicare

CMS Executes About-Face on Pre-Dispute Arbitration Ban

By Christopher J. Shaughnessy on August 8, 2017
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Long-Term Care Providers ("LTC")

The Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule on June 5, 2017, that serves as an effective course reversal on pre-dispute arbitration agreements in a long-term care (“LTC”) setting. This caps off an effort by many in the healthcare and nursing home industry to stop the prior rule, which banned such agreements, from taking effect. More >

Tags: American Health Care Association, Centers for Medicare & Medicaid Services, CMS, Federal Arbitration Act, Health Care Law, Long-Term Care, LTC, Nursing Care, nursing homes, Pre-dispute arbitration

"Incident to" Billing - Easy to Get Wrong

By Lisa English Hinkle on July 17, 2017
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Billings, Locum Tenens, Medicaid

Billing for medical services is never easy. Despite attempts by the Centers for Medicare & Medicaid Services (“CMS”) to simplify the rule regarding “incident to” billing for Medicare services, it remains misunderstood by a large swath of providers. This proves problematic, as incorrect billing practices may lead to overpayments and False Claims Act violations. Billing for “incident to” services is an important mechanism to reflect the actual value of mid-level services provided under the specific plan of a physician. When properly followed, the “incident to” rules allow physicians to bill for services provided by non-physician practitioners as if they were performed by the physician at physician reimbursement rates. Additionally, the non-physician provider can be an employee, an independent contractor or even a leased employee, provided that they are supervised by a physician and the requirements are met. Because of the confusing nature of allowing a physician to bill for services he or she did not directly provide to the patient, serious landmines exist that can create problems if the rules are not scrupulously followed and documented. More >

Tags: "Incident to", Centers for Medicare & Medicaid Services, False Claims Act, Medicaid, Non-physician practitioners
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