Articles and Blogs

On October 24, 2018, Congress enacted a new law titled the Eliminating Kickbacks in Recovery Act of 2018 (“EKRA”) as part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (“SUPPORT Act”). The SUPPORT Act is a comprehensive law that seeks to combat the opioid... READ MORE

On November 21, 2018, the Department of Health and Human Services Office of Inspector General (“OIG”) released a report (“Report”) outlining what it believes are multiple deficiencies in the Medicare wage index system. OIG recommended several changes, including revisiting the possibility of comprehensive reform and seeking authority to penalize hospitals that submit inaccurate wage... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) recently issued a proposed rule (“Proposed Rule”) that would require pharmaceutical manufacturers to disclose the list price for a typical course of treatment of prescription drugs and biologics covered by Medicare or Medicaid in direct-to-consumer television advertisements. This policy development comes just two months after the... READ MORE

NATIONAL Amazon adds to its list of HIPAA-eligible machine learning tools Leapfrog releases Fall 2018 safety grades showing medical errors, safety issues prevail in red and blue states Hospital CEOs Agree That Systemness Focus Drives Results Doctors as disruptors? AMA CEO says medicine’s future demands it 93% of MIPS-eligible clinicians to get positive payment... READ MORE

Health and Human Services (“HHS”) Secretary Alex Azar announced on Thursday, November 8, 2018 that HHS intends to reconsider some of the episode-based payment models that it withdrew almost one year ago. According to Secretary Azar, HHS is exploring new and improved episode-based payment models, including a mandatory bundled payment model for radiation oncology.[1]... READ MORE

On November 1, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“MPFS Final Rule”). Among many other changes, CMS finalized maintaining payments for certain non-excepted (non-grandfathered) off-campus provider-based hospital departments (“PBDs”) at 40 percent of the Outpatient Prospective Payment... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) Center for Medicare and Medicaid Innovation proposed to lower the cost of Medicare Part B outpatient prescription drugs by establishing their prices based on lower drug prices of other advanced industrial nations as compiled in an “international price index” (“IPI”) and changing the way the current drug... READ MORE

NATIONAL DJO launches 1st outpatient arthroplasty risk assessment tool Hospitals slammed with $380M in CMS cuts, industry cries foul CMS finalizes site neutral payment rule AHA says payer consolidation, not hospital prices, raises healthcare costs 3 changes potentially coming to HIPAA OCR Announces Next Round of HIPAA Audits Will Focus on Enforcements CMS Publishes... READ MORE

On November 8, 2018, CMS released a letter to clinicians regarding E/M documentation and coding reform. This follows the CY 2019 Medicare Physician Fee Schedule Final Rule intentions to reduce burden on clinicians in furtherance of the agency’s “Patients Over Paperwork” initiative. Effective January 1, 2019, CMS will: Simplify the documentation of history and exam... READ MORE

On September 7, 2018, the United States Food and Drug Administration (“FDA”) issued a revised draft Memorandum of Understanding (“MOU”) that would govern interstate dispensing and distribution of “inordinate amounts” of compounded prescription drugs by certain compounding physicians and pharmacies. The concept of this MOU first appeared in the Compliance Policy Guidance issued by... READ MORE