Articles and Blogs

On April 27, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a much anticipated proposed rule (“Proposed Rule”) for the transition to a new Merit-Based Incentive Payment System (“MIPS”) and alternative payment models (“APMs”) pursuant to the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (“MACRA”). As background, MACRA... READ MORE

On April 21, 2016, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced a $2.2 million settlement with a New York hospital (“Hospital”) stemming from unauthorized patient filming by ABC’s NY Med television show. In what OCR called an egregious disclosure of protected health information (“PHI”) in violation of... READ MORE

In an interim final rule published in the Federal Register on April 21 (“Rule”), the Centers for Medicare & Medicaid Services (“CMS”) amended its regulations to allow PPS hospitals located in urban areas to obtain a “412.103” urban to rural reclassification and also be reclassified for wage index purposes by the Medicare Geographic Classification... READ MORE

On May 6, 2016, CMS will publish its new Medicaid managed care rule, which will permit states to require Medicaid MCOs1 to make enhanced payments to targeted hospitals, physicians and nursing facilities for a limited number of years. This is a departure from current practice in which states are prohibited from directing a Medicaid... READ MORE

On April 19, 2016, the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) reached a settlement in the amount of $755,000 with a North Carolina orthopedic clinic (“Clinic”) for failing to execute a business associate agreement with a third-party vendor. This is OCR’s second settlement this year related to business... READ MORE

On April 18, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released its Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital Proposed Rule Issues for Fiscal Year 2017, which are set to be published on April 27, 2016. CMS included a proposed rule for implementing the Notice of Observation Treatment... READ MORE

This week, the Centers for Medicare & Medicaid Services (“CMS”) announced that it is extending participation in the Bundled Payments for Care Improvement (“BPCI”) initiative through September 30, 2018. Awardees in the BPCI initiative can now extend their participation in Models 2, 3 and 4 until that date. Originally, awardees that began in October... READ MORE

In the proposed Inpatient Prospective Payment System (“IPPS”) rule for FFY 2017, hospitals will benefit from the restoration of payments CMS has taken away from hospitals since FFY 2014, related 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... READ MORE

On April 15, 2016, the Food and Drug Administration (“FDA”) issued three important draft guidance documents that clarify the standards under Sections 503A and 503B of the federal Food Drug & Cosmetic Act (“the Act”) applicable to compounding activities carried out by prescription drug compounders. These compounders include hospital pharmacies, non-hospital pharmacies (including retail... READ MORE

Secondary Payer Refunds, Overpayments and Obligations CMS’s new rule regarding the reporting and returning of Medicare overpayments (effective March 14, 2016) makes clear that secondary payer refunds owed by health care providers to Medicare may become overpayments for purposes of the new rule. Without sufficient oversight, such overpayments may expose a health care provider to... READ MORE