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Showing 17 posts tagged Centers for Medicare & Medicaid Services.

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

ALERT – ACA Section 1557 Now in Effect – Is your rural health clinic in compliance?

November 9, 2016
Posted In Affordable Care Act, Patient Protection and Affordable Care Act (“ACA”), Rural Health Clinic

On October 16th, Section 1557 of the Affordable Care Act (“ACA”) went into effect, requiring all recipients of money from federal health care programs to provide language assistance for individuals with Limited English Proficiency at no cost. This section applies to rural health clinics (“RHCs”) as well, which means they must now comply with notice and assistance regulations as well as grievances in the cases of larger entities.  More >

Tags: Centers for Medicare & Medicaid Services, CMS, Medicaid, Medicare, Section 1557

Implied False Certification - Supreme Court Upholds New False Claims Act Standard

By Christopher J. Shaughnessy on July 5, 2016
Posted In False Claims Act

While the news for healthcare practitioners regarding regulatory liability under Federal law had largely been positive as of late, the Supreme Court of the United States upheld a new standard of liability under the False Claims Act in the case of Universal Health Services v. United States ex rel. Escobar. The standard of liability approved by SCOTUS is referred to as “implied false certification” and the implications for healthcare providers are numerous. More >

Tags: Centers for Medicare & Medicaid Services, implied false certification, Medicaid, Medicare, SCOTUS, United States Supreme Court, Universal Health Services v. United States ex rel. Escobar

CMS Issues Proposed Rule to Cast a Wide Program Integrity Net

By Anne-Tyler Morgan on May 3, 2016
Posted In Centers for Medicare & Medicaid Services (“CMS”), Medicare

On March 1, 2016, the Centers for Medicare & Medicaid Services (“CMS”) quietly issued a proposed rule that would give the agency far-reaching tools in the area of program integrity enforcement. On its face, the Rule addresses enrollment and revalidation reporting requirements for Medicare, Medicaid and CHIP, but it also significantly increases its authority with regard to the denial or revocation of providers’ Medicare enrollment. More >

Tags: Affordable Care Act (ACA), Centers for Medicare & Medicaid Services, Medicare, program integrity, Proposed Rule

CMS finalizes the 60-day overpayment rule and providers can breathe a little easier

By Anne-Tyler Morgan on March 22, 2016
Posted In Centers for Medicare & Medicaid Services (“CMS”), False Claims Act, Medicaid, Medicare

The wait is over – in February, the Centers for Medicare & Medicaid Services (“CMS”) released its Final Rule on identifying, reporting, and returning overpayments to the Medicare and Medicaid programs. This rule is the result of provisions in the Patient Protection and Affordable Care Act (“ACA”) which created a 60-day safe harbor during which providers can identify overpayments by the two major federal healthcare programs. If a provider fails to report an overpayment within 60 days of the date that it was identified, the overpayment may be considered a violation of the federal False Claims Act (“FCA” - for more information on the FCA, please read my earlier blog posts). The Final Rule implementing this provision became effective on March 14, 2016. More >

Tags: 60-day rule, Centers for Medicare & Medicaid Services, CMS, False Claims Act, Kane v. Continuum Healthcare Providers, Inc., Medicaid, Medicare, overpayments
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