Articles and Blogs

Recently providers have had success challenging CMS rules, as well as its failure to properly promulgate them. In Ruling 1727-R, issued April 23, 2018, CMS acquiesced to the decision in Banner Heart v. Burwell, invalidating CMS’s regulation prohibiting appeals unless they stemmed from a cost report adjustment or a protested item. In Banner, the... READ MORE

NATIONAL Payer Roundup—CMS delays 340B rule … again A Collaboration to Keep Physicians at the Center of Healthcare ManorCare Mega-Deal Blurs Care Lines, But Will Doctors Buy In? CMS Chief Fires Back at Critics FDA chief Gottlieb to pharma: Those rebates you love to hate may soon count as kickbacks Healthcare a bright spot... READ MORE

On May 7, 2018, CMS published its inpatient prospective payment system (“IPPS”) proposed rule (“Proposed Rule”). The Proposed Rule addresses a variety of provider topics, and this article discusses three noteworthy issues related to graduate medical education (“GME”). First, CMS announced the next two rounds of GME slot redistribution through the closed hospital slot... READ MORE

On April 24, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule for the CY 2019 Inpatient Prospective Payment System (“Proposed Rule”). Among many other changes, one very important change stands out in the Proposed Rule, specifically eliminating the requirement that providers record a written inpatient admission order in the medical... READ MORE

NATIONAL There’s an acute nursing shortage, but schools are rejecting thousands of applicants Joint Commission wants increased focus on workplace violence in healthcare Health IT Trade Groups Push CMS for MIPS 90-Day Reporting Period FDA chief moves to promote artificial intelligence in health care Expert tips for incentivizing physicians to embrace value-based care Where... READ MORE

The FFY 2019 IPPS Proposed Rule (“Proposed Rule”) was released on April 24, 2018, and CMS published the associated tables on its website. It is expected that the Proposed Rule will be published in the Federal Register on May 7. The release of the Proposed Rule and the accompanying tables triggers the start to... READ MORE

In the continually evolving world of Medicare coverage and payment rules, hospital compliance personnel must look broadly to identify potential risk areas to be addressed within their organization. Based on the facts alleged in two recent False Claims Act qui tam cases, with one of those cases currently proceeding through the federal courts, hospitals... READ MORE

On February 15, 2018, the Office of Inspector General (“OIG”) released a report announcing the results of a review it conducted of outpatient hyperbaric oxygen therapy (“HBO therapy”) claims. Of the 120 sampled outpatient claims under review, OIG found payment was made in accordance with Medicare requirements for only 18 claims. The audit, included... READ MORE

NATIONAL Feds Take CMS to Task Over Improper Telehealth Reimbursements Medicare Advisers Recommend Payment Cuts To Many Free-Standing ERs Amazon drops plan to become a major pharmaceutical distributor 17 of the highest-paid CEOs in healthcare Staff recruitment and retention in the age of clinician shortages: 2 experts weigh in Millennial doctors care about culture... READ MORE

Consistent with earlier policy announcements, on April 3, 2018, the Antitrust Division of the U.S. Department of Justice (“DOJ”) announced that it reached a settlement with Knorr-Bremse AG and Westinghouse Air Brake Technologies Corporation (“Wabtec”), two large rail equipment suppliers. The settlement resolves a lawsuit alleging the companies had maintained unlawful agreements not to... READ MORE