Articles and Blogs

We recently released an alert about the expiration of exception processes for the Medicare therapy caps as of January 1, 2018. Since that article, the Bipartisan Budget Act of 2018 was signed into law and includes a permanent fix to the therapy caps effective back to January 1, 2018. Therapy providers should review the... READ MORE

NATIONAL Tech’s Next Big Wave: Big Data Meets Biology Hospitals Acquired 5K Independent Practices from 2015 to 2016 CMS promises more APM’s, continued flexibility, better alignment of reporting tracks for MACRA CMS official: Moving physicians into advanced APMs under MACRA a ‘top strategic goal’ Five areas of the highest physician pay in the US... READ MORE

Last week, Cigna Corporation, the fifth largest health insurer in the country, and Express Scripts, the nation’s largest stand-alone pharmacy benefit manager (“PBM”), issued a statement outlining Cigna’s plans to acquire the PBM giant for $67 billion. This deal is just the latest example of a health insurer and PBM joining forces, coming just... READ MORE

NATIONAL Google Unveils New Cloud Service for Health Care Nurse shortage: Healthcare organizations pull out all the stops to attract and retain experienced RNs More than 60% of healthcare orgs saw cyberattack in past year, survey finds Hospitals eye concierge medicine to lure patients, boost revenue Cigna To Spend About $52 Billion For Express... READ MORE

On February 15, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released a long-awaited Final Decision Memo (the “Memo”) updating the National Coverage Determination for implantable automatic defibrillators (NCD 20.4), also known as Implantable Cardioverter Defibrillators (“ICDs”). CMS’s update to NCD 20.4, the guidance describing when providers may bill and receive payment from... READ MORE

NATIONAL No-frills micro hospitals with as few as 8 rooms emerge as a new way to cut health-care costs Doctors can now call Uber for patients, ditching taxi vouchers Ocular Telehealth Battle Heats Up With New Group, Lawsuit Appeal Bracket partners with Uber Health to ease clinical trial site, patient burden A New taskforce... READ MORE

After informal communications with the Centers for Medicare & Medicaid Services (“CMS”) Central Office, it appears that edits that impact Critical Access Hospital (“CAH”) Method II claims have been overreaching. Specifically, reason codes 17713, 17714, 17716 and 17717 should not be applying to the facility charges on CAH Method II claims. These reason codes... READ MORE

On Tuesday, February 27, 2018, Attorney General Jeff Sessions announced the creation of the U.S. Department of Justice (“DOJ”) Prescription Interdiction & Litigation (“PIL”) Task Force in an ongoing effort to curb the country’s current prescription opioid crisis. According to DOJ’s press release, the PIL Task Force will “aggressively deploy and coordinate all available... READ MORE

On February 23, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued guidance that may result in fewer denials of claims made by Inpatient Rehabilitation Facilities (“IRFs”) for services (“Guidance”). Based on the Guidance, beginning March 23, 2018, Medicare contractors cannot make claim denials exclusively on the basis of a failure to meet... READ MORE

NATIONAL CMS moves forward with new voluntary bundled payment AMA seeks MAT changes to combat opioid crisis 35 hospital groups urge court to halt $1.6B in Medicare payment cuts 20 states file lawsuit against federal government calling the Affordable Care Act unconstitutional Moody’s warns hospitals to beware of payer growth strategies on margins, bargaining... READ MORE