Articles and Blogs

CMS has issued the final Inpatient Prospective Payment System (“IPPS”) rule for FFY 2017, restoring payments CMS has taken away from hospitals since FFY 2014, which relates to implementation of the Two-Midnight Rule that redefined the definition of inpatient admissions. Not only will there be no 0.2 percent decrease in IPPS payments in FFY 2017, but... READ MORE

This is the third article in a series discussing the Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) final rule (“Final Rule”) implementing Section 1557 of the Patient Protection and Affordable Care Act (“ACA”). Failure to comply with the Final Rule can result in the loss of federal funding, and... READ MORE

Updated August 30, 2016 The Wisconsin Board of Nursing (“BON”) recently approved revisions to Wisconsin Administrative Code N 8 (“N 8”), the regulations governing advanced practice nurse prescribers (“APNPs”) in Wisconsin. An APNP is a nurse practitioner, nurse-midwife, certified registered nurse anesthetist or clinical nurse specialist who has been granted a certificate by the... READ MORE

As proposed by CMS, physicians and other MIPS1 eligible clinicians in physician groups that participate in the Oncology Care Model (“OCM”) would be subject to a MIPS scoring methodology different from the scoring methodology applied to most MIPS eligible clinicians, at least during the first year of MIPS.  The unique scoring methodology is likely... READ MORE

On July 6, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule addressing potential modifications to the Hospital Value-Based Purchasing Program (“Proposed Rule”).1 The Proposed Rule, if implemented as currently drafted, would eliminate the Pain Management dimension from the Hospital Value-Based Purchasing (“VBP”) Program’s Hospital Consumer Assessment of Healthcare Providers... READ MORE

Since the first large U.S. health care ransomware demand hit the news in early 2016, attacks have been increasing in visibility and frequency, reaching a claimed 4,000 attacks per day. Ransomware is a kind of malware that infects computer systems, restricting access to systems or to data until a “ransom” is paid to the... READ MORE

The Office for Civil Rights (“OCR”), Department of Health and Human Services (“HHS”), emailed notices to 167 covered entities on July 11, 2016 informing them they were selected for a HIPAA Phase II audit. Health care providers, health plans and health care clearinghouses were randomly selected by OCR from the audit pool. If your organization... READ MORE

In late 2015, the Federal Trade Commission (“FTC”), riding a wave of victories, challenged three separate hospital mergers in Harrisburg, Pennsylvania; Huntington, West Virginia; and Chicago, Illinois (for more information on these challenges, see our previous coverage here). Six months later, the FTC’s winning streak has effectively come to an end after suffering at... READ MORE

On July 6, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued its much anticipated proposed rule for the CY 2017 Hospital Outpatient Prospective Payment System (“Proposed Rule”). Among many other changes, the Proposed Rule addressed the implementation of Section 603 of the Bipartisan Budget Act of 2015 (“Section 603”), which excludes many... READ MORE

In June, the Department of Health and Human Services Office of the Inspector General (“OIG”) issued a report addressing, in part, the Centers for Medicare & Medicaid Services’ (“CMS”) oversight of provider-based billing. This report was based on OIG’s survey and review of provider-based practices over the last several years. In the report, OIG... READ MORE