Articles and Blogs

The U.S. Department of Health and Human Services (“HHS”) published in the Federal Register the 2018 updated civil monetary penalties (“CMPs”) adjusted for inflation as required by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 (§701 of Pub. Law 114-74) (the “Act”). The updated CMPs became effective on the date of... READ MORE

On October 25, 2018, the president signed a wide-ranging bipartisan legislative package to address the opioid epidemic. The enactment of the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or the SUPPORT for Patients and Communities Act, (the “Act”) follows a lengthy process in both the Senate and... READ MORE

NATIONAL After stalling for months, HHS plans to accelerate 340B changes Hospitals could save $11M per year by streamlining supply chain services Time Magazine: The Health Care 50: Fifty people transforming health care in 2018 OCR Drafts NPRM on ‘Good Faith’ Patient Data Disclosure Rules Consumerism driving hospitals to break down cybersecurity boundaries OIG:... READ MORE

In September 2018, HHS Office of Inspector General (“OIG”) issued audit Report No. A-01-15-00500 (the “Report”) finding that out of 220 randomly sampled inpatient rehabilitation facility (“IRF”) stays from 2013, nearly 80 percent did not meet Medicare coverage and documentation requirements. Specifically, for 175 of the 220 sampled stays at 135 IRFs, the medical record... READ MORE

NATIONAL Healthcare job growth continues; hospitals add 12K positions in September 12 recent hospital, health system outlook and credit rating actions MGMA18: Physicians frustrated over lack of advanced APMs Want your medical records? Better be prepared to call—and pay up Hospitals and physician groups take on risk in BPCI Advanced model 10 informative Q&As... READ MORE

To be paid by Medicare, Organ Procurement Organizations (OPOs) and transplant centers must be members of the United Network for Organ Sharing (UNOS), which manages the Organ Procurement and Transplantation Network (OPTN). Transplant centers and OPOs must comply with multiple oversight agencies and requirements, including OPTN policies and guidelines and the Medicare Conditions of... READ MORE

NATIONAL Verma puts Medicaid insurers on notice, says CMS will begin ‘targeted audits’ While surgery centers support CMS payment proposal, hospital groups submit harsh criticism Supreme Court to hear DSH payments case Banner Health, Ascension executives join hundreds of hospital CEOs defending 340B program MGMA shares physician practice keys to success MGMA18: Underwhelming MIPS... READ MORE

On September 17, 2018, the U.S. Department of Justice (“DOJ”) approved the $52 billion vertical merger between health insurer Cigna Corp. (“Cigna”) and pharmacy benefit manager (“PBM”) Express Scripts. The Cigna-Express Scripts merger is just one in a string of recent health insurer/PBM acquisitions. For more on these transactions, click here. As the largest unaffiliated... READ MORE

NATIONAL How providers can innovate to combat physician burnout CMS: Innovative new payment models are coming—and some will be mandatory Lack of consistent process hinders data sharing among HHS agencies, report finds Apple Watch Should Pave Way for More Medical Gadgets, FDA Says Pharma lobby mounts last-ditch effort to fix prescription ‘doughnut hole’ Less... READ MORE

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“Proposed Rule”). Among many other changes, CMS proposed numerous modifications to the required documentation for evaluation and management (“E/M”) visits in order to alleviate the administrative burden on practitioners and... READ MORE