Articles and Blogs

NATIONAL How 6 major health systems and hospitals hope to boost housing Medicare trims payments to 800 hospitals, citing patient safety incidents CHIME to Congress: HIPAA isn’t enough to ensure cybersecurity Breast cancer screening bundled payment model incentivizes cost savings Value-based care shift among highlights of MGMA 19 financial conference Freestanding EDs charge up... READ MORE

Location, location, location – this will be the focus of a Medicare hospital claims processing requirement. Starting in April 2019, CMS will activate billing edits that will Return to Provider (“RTP”) any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare enrolled location identified in Provider... READ MORE

During a speech on March 4, 2019, Secretary of Health and Human Services Alex Azar announced that the Trump administration plans to overhaul the Medicare payment system for certain dialysis services provided to patients with end-stage renal disease. The overhaul, as envisioned, would incentivize moving the place of treatment from outpatient clinics to home... READ MORE

Over the years, there have been a number of federal cases involving allegations that health care providers used improper real estate arrangements to induce referrals. Recently, two real estate-related cases have made headlines. Hospitals should pay careful consideration to the following two cases. Serial Whistleblower Seeks to Overturn Ruling Involving Alleged Cash-Flow Subsidies under... READ MORE

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

On January 29, 2019, the Department of Health and Human Services Office of Inspector General (“OIG”) published Advisory Opinion 19-02, which approved an arrangement allowing a pharmaceutical manufacturer to loan smartphones to financially needy patients in order to assist with medication adherence. OIG stated that it would not impose sanctions against the parties for... READ MORE

Recently, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a favorable advisory opinion, Advisory Opinion 19-01, concerning a charitable pediatric clinic (the “Clinic”)’s arrangement under which the Clinic waives cost-sharing amounts for a small percentage of TRICARE and Medicare beneficiaries not covered by a state insurance program (the “Arrangement”). After... READ MORE

The U.S. Department of Justice and the Office of the Inspector General of the United States Department of Health and Human Services announced this month news of a Settlement Agreement and a Corporate Integrity Agreement (the “Agreements”) with Greenway Health, LLC (“Greenway”). The Agreements include a payment by Greenway of $57.25 million. Greenway customers... READ MORE

NATIONAL How to make healthcare more like Amazon? It comes down to data and payer-provider collaboration How hospitals will handle outpatient competition & disruption in 2019 White House reportedly reviewing final rule to reverse nursing home arbitration ban CMS Lifts Moratoria on Home Health After 5 Years Amazon’s PillPack secures more state licenses, could... READ MORE

S&P Global Ratings, Fitch Ratings and Moody’s Investors Service recently released their Nonprofit Healthcare 2019 Outlooks, which are largely consistent with 2018, despite changes in the health care industry over the past year. Fitch and Moody’s issued negative outlooks for the nonprofit health care sector, while S&P’s sector outlook was stable. Despite their differing... READ MORE