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McBrayer Blogs
SCOTUS Blocks OSHA ETS; Healthcare Mandate Moves Forward
Thursday afternoon, the United States Supreme Court ruled to block the Emergency Temporary Standard (ETS) issued by the U.S. Occupational Safety and Health Administration (OSHA) that would require private employers of 100 or more workers to mandate employee vaccination against COVID-19, or weekly testing for the virus. The Court upheld, however, a similar rule for healthcare employers contracted with the Centers for Medicare and Medicaid Services (“CMS”) as further outlined below. More >
Not All Surprises Are Presents: Preventing Surprise Medical Bills under the No Surprises Act
To address surprise medical costs for consumers, Congress recently passed an extremely complicated bill: No Surprises Act (“The Act”). No Surprises Act aims to prevent surprise medical bills or balance billing in the American health care system. Specifically, The Act prevents surprise medical bills when patients receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center. More >
Vaccination Mandate for Healthcare Facilities Blocked by Federal Court
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 >
Policy Reversal Means Return of Per Day Fines for Nursing Homes
On July 19, 2021, the Center for Medicare and Medicaid Services (“CMS”) rescinded a guidance issued in 2017 that significantly limited the discretion of CMS Locations to impose substantial fines for noncompliance.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 >
Pandemic Pivot to Telemedicine Creates New Compliance Issues for Healthcare Providers
The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use. In April of 2019, the Centers of Medicare and Medicaid Service (CMS) finalized rules to increase telehealth benefits for Medicare Advantage enrollees, effectively incentivizing health systems with high numbers of private Medicare plan recipients to invest in telehealth services. More >
FDA Approval Means Smoother Road to Vaccine Mandates for Healthcare Employers
Amidst the new surge of COVID-19 cases in the U.S. due to the highly contagious Delta variant, the Food and Drug Administration (FDA) has announced that the Pfizer-BioNTech vaccine, one of three that has been available under Emergency Use Authorization, has achieved full approval. As the need for a fully vaccinated healthcare workforce grows more critical, this FDA announcement paves a smoother path for healthcare facilities’ employee vaccine mandates. Healthcare employers should understand how to implement an effective vaccine mandate to protect the health and safety of their employees and patients. More >
Healthcare Providers Take Notice: AMA Updates E/M Codes for 2021
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 >
The 2020 CARES Act: Caring About Substance Abuse Treatment Document ("SUD") Privacy
As of March 8th, 2021 there were more than 28,813,424 cases and 523,850 COVID-19-related deaths in the U.S., representing 20% of the world's known COVID-19 deaths, and the most deaths of any country.[1] More >
A Christmas Miracle! Congress Agrees on a New Coronavirus Relief Bill
After nine months of negotiations and stalemates, Congress finally reached an agreement for a $900 billion relief package on December 20, 2020. Included are many familiar provisions from the March CARES Act, with a particular emphasis on small business benefits and relief for health care providers. More >
Malnutrition Diagnosis Codes: The Compliance Danger You’re Not Taking Seriously Enough
It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks. More >
