Articles and Blogs

NATIONAL Rural hospital closings cause mortality rates to rise, study finds Medicare spends more on post-hospital care than private insurers Public comment period to close Sept. 27 for federal price transparency rule HIPAA: At what cost? It’s showtime: Providers, supporting cast members hustle to handle changes under PDPM 4 issues on nurse leaders’ radar... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) could revoke or deny a provider’s or supplier’s Medicare enrollment if it determines that any of its affiliations pose an “undue risk” under a Final Rule announced on September 5, 2019 (“Enrollment Rule”). Also under the Enrollment Rule, providers and suppliers (“Providers”) selected by CMS will... READ MORE

NATIONAL Physician pay increased in 2018 while productivity remained stagnant HHS Secretary Azar mulls Brett Giroir as next FDA commissioner 3 strategic differences between nonprofit and for-profit hospitals Physician viewpoint: 10 areas in which AI will transform primary care How providers can outperform their peers on MIPS regardless of what CMS changes Tougher inspections,... READ MORE

CMS recently posted reminders regarding the availability of MIPS final scores and the deadline to request review if an error has been made: “If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are available for review on the Quality... READ MORE

In 2014, Congress enacted the Protecting Access to Medicare Act (“PAMA”), changing the landscape of Medicare reimbursement for lab services. PAMA required the Centers for Medicare & Medicaid Services (“CMS”) to establish a single, national Clinical Laboratory Fee Schedule (“CLFS”) based on current charges in the private health care market. Below, we provide background... READ MORE

 NATIONAL State-by-state breakdown of 113 rural hospital closures 6 Expectations Millennials Have For Their Healthcare Advice for new ASC administrators from Simplify ASC’s DeeDee Dalke The most dangerous trend in health IT from 5 execs Mystery group spent $13M on surprise-billing ads Johnson & Johnson Ordered to Pay $572 Million in Landmark Opioid Trial... READ MORE

In recent years, many health care providers have dedicated substantial resources to community health or initiatives targeted at improving social determinants of health. As outlined in a recent Hall Render article, the Tax Cuts and Jobs Act of 2017 gives health care providers a mechanism for furthering such goals while realizing significant tax savings... READ MORE

A federal district court in Connecticut recently applied the Supreme Court’s favorable opinion in the Allina case (which we previously wrote about here), compelling the Secretary to adhere to notice-and-comment rulemaking of Medicare policy when it affects providers’ eligibility, benefits or payment. Additionally, CMS cannot use a preclusion statute to avoid challenges for which it did not... READ MORE

It is no surprise that state and federal legislators are taking action to address the issue of unexpected medical bills, otherwise known in the health care industry as “surprise billing.” Surprise billing generally occurs when a patient receives care at an out-of-network facility (often emergency care) or from an out-of-network provider at an in-network... READ MORE

In late July 2019, CMS issued claims processing requirements for the educational and operations testing period for appropriate use criteria (“AUC”) related claims for advanced diagnostic imaging. Advanced imaging includes CT, PET, nuclear medicine, and MRI. The testing period begins January 1, 2020. The CMS Program Transmittal can be found here. Background The Protecting... READ MORE