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

CMS Rule on Medicare Overpayments? Don’t Hold Your Breath

March 12, 2015
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Medicaid, Medicare, Patient Protection and Affordable Care Act (“ACA”)

Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a final ruling. Unfortunately, providers’ anticipation for a final ruling will have to continue. On February 16th, CMS announced that it would delay the final rule on reporting and returning overpayment…by another full year! More >

New Rule on Medicare Reimbursement for Chronic Care Management Services

February 5, 2015
Posted In Centers for Medicare & Medicaid Services (“CMS”), Chronic Care Management, Medicare

In November 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final regulation with changes intended to ensure Medicare’s payment system “reflect[s] changes in medical practice and the relative value of services, as well as changes in the statute.”[1] One of the beneficial changes for physicians is the new Medicare reimbursement of chronic care management (“CCM”) services, which began with the New Year on January 1, 2015. All providers should pay special attention to the essential requirements for chronic care management reimbursement and begin identifying eligible fee-for-service Medicare patients. More >

ENROLLMENT: A NEW ENFORCEMENT TOOL?

December 10, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicare

On December 3, 2014, CMS issued its Final Rule that addresses provider enrollment. These new rules create new tools to police provider enrollment. CMS now has the ability to deny enrollment of providers, suppliers and owners who have been affiliated with an entity that has unpaid Medicare debt. CMS has announced that this provision will help prevent individuals and entities from incurring substantial Medicare debt, leaving the Medicare program, and then re-enrolling as a new business to avoid repayment of the outstanding Medicare debt. CMS has announced that it will only enroll eligible individuals or entities if they repay the debt or enter into a repayment plan. More >

HHS OIG RELEASES FISCAL YEAR 2015 WORK PLAN

November 19, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Office of Inspector General of the United States Department of Health and Human Services (OIG)

Recently, the Office of Inspector General of the United States Department of Health and Human Services (“OIG”) released its Fiscal Year 2015 Work Plan summarizing its oversight and enforcement priorities for the 2015 Fiscal Year. Here are some highlights from the Work Plan. More >

Telehealth/Telemedicine: An Opportunity for Physicians and Providers to Add a New Line of Service

November 18, 2014
Posted In American Telemedicine Association (“ATA”), Centers for Medicare & Medicaid Services (“CMS”), Federation of State Medical Boards (“FSMB”), Health Care Law, Health Information Technology for Economic and Clinical Health Act (HITECH Act), Healthcare Information and Management Systems Society (HIMSS), Hospitals, Kentucky Board of Medical Licensure, Kentucky Medical Practice Act, Medicaid, Medicare, Personal Health Information, Telehealth, Telemedicine

The cost effectiveness of providing health care via telemedicine or telehealth promises to be an effective tool to increase coverage and reimbursement of healthcare provided remotely or through telehealth. Towers Watson, a national consulting company, recently published a 2014 study that suggests that telemedicine could save $6 billion annually for the health care industry. "Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states," according to Dr. Allan Khoury, a senior consultant at Towers Watson.[1] Recent studies have assigned significant cost savings generated by telehealth use that include cost savings of $537 million per year for emergency departments using telehealth to reduce transfers and spending reductions of 7.7% to 13.3% per person per quarter in the cost of care for chronically ill Medicare beneficiaries using a health buddy via telehealth. [2] As the cost effectiveness of providing services via telehealth and telemedicine is proven, Medicare, most state Medicaid programs and commercial insurers are increasing coverage as well as reimbursement for telehealth services. State law requirements for providing telehealth and coverage differ greatly. Consequently, physicians and health care providers should be aware of the complexity of providing telehealth and its requirements, but should also incorporate telehealth services into their practices as a new way of providing services and a new line of business. More >

The Finalized Meaningful Use Rule – What Providers Need To Know

September 30, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Compliance Programs, EHR Systems, Electronic Health Records (“EHR"), Health Care Law, Meaningful use incentives

The Centers for Medicare and Medicaid Services (“CMS”) finalized a rule (“Final Rule”) on August 29, 2014, giving health care providers a bit more breathing room to comply with the Electronic Health Record (“EHR”) Incentive Program’s (“the Program’s”) meaningful use requirements. The Program began as a way to motivate health care providers to implement EHR systems. Hospitals and health care professionals can qualify through the Program for incentive payments from CMS for the “meaningful use” of certified EHR technology (“CEHRT”). What qualifies as “meaningful use” has been the source of much confusion. The Program is intended to be implemented in three stages, with each stage to be completed within one calendar or fiscal year. More >

Medicare Part D Prescribers Must Act Now

June 12, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicaid, Medicare, Part D

On May 19, the Centers for Medicare & Medicaid Services (“CMS”) issued final regulations which require doctors prescribing drugs for Part D patients to enroll in Medicare. In addition, the regulations establish authority for CMS to revoke a doctor's Medicare eligibility for abusive prescribing practices, among other provisions. The regulations are part of the ongoing effort to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs. More >

Physicians Facing an Increased Risk of Qui Tam Suits

June 5, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Health Care Law, Medicare

On April 9, the Centers for Medicare and Medicaid Services (“CMS”) released data showing physicians’ compensation for Medicare Part B billing payments in 2012. It was the first time in more than 35 years the data has been made available to the public and it unleashed a fire storm of national headlines. Most news outlets, unfortunately, failed to explain the facts behind the figures. More >

Tips for New Enrollment & Revalidation for Participation in Medicare & Medicaid

June 3, 2014
Posted In Centers for Medicare & Medicaid Services (“CMS”), Chain and Organization System (“PECOS”), Medicaid, Medicare

The new enrollment and revalidation requirements for providers and suppliers for Medicare/Medicaid participation was previously  detailed on this blog. As promised as a follow-up, this blog post will describe enrollment best practices and tips for ensuring that enrollment or revalidation is properly accomplished. Not only is initial enrollment now more onerous, but revalidation is required for all physicians and other providers/suppliers who were enrolled before March 25, 2011, which generally means that all physicians and physician groups must complete the re-enrollment process. A failure to re-enroll means that CMS will de-activate payment until a successful re-enrollment process is completed. In some cases, CMS may even revoke participation. Thus, it is crucial that physicians, providers, and suppliers get it right the first time. More >

FINALLY SOME RELIEF TO PROVIDERS—CMS ORDERED TO NO LONGER APPLY A COMMON RULE OF THUMB WHEN AUDITING

May 30, 2014
Posted In Audit, Centers for Medicare & Medicaid Services (“CMS”), Jimmo v. Sebelius, Maintenance Standard

Health care providers are always at risk of a payor audit, and contracted auditors seem to be more aggressive now than ever. While MIC, MAC, and ZPIC audits as well as pre-payment reviews of late have become more efficient with the use of rules of thumb to flag specific codes commonly misapplied, the U.S. District Court of Vermont’s ruling in Jimmo v. Sebelius puts the brakes on such fishing expeditions.   In holding that, in the case of skilled nursing services, there is no “improvement standard” and claims should be reviewed on a case by case basis, the court has limited CMS in its ability to apply arbitrary standards in denying reimbursement for covered services. More >

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