Articles and Blogs

Inpatient-Only Procedures. Earlier this month, CMS quietly revised its billing policy related to inpatient-only procedures.  In a Transmittal issued on March 13, CMS included inpatient-only procedures provided in the outpatient setting as preadmission services subject to the Three-Day (One-Day) Payment Window Rule.  Effective April 1, hospitals can bill Medicare for inpatient-only procedures provided to... READ MORE

Summary of the Bill The United States House of Representatives overwhelmingly approved a measure this week to repeal the Sustainable Grow Rate (“SGR”), which has been used to determine Medicare physician payment rates for more than a decade.  The SGR was established as part of the Balanced Budget Act of 1997 as a method... READ MORE

In January, HHS Secretary Sylvia Burwell announced that HHS is accelerating Medicare’s transition to “alternative payment models.”  HHS’s goal is to shift 30 percent of all Medicare provider payments to alternative payment models by 2016 and for 50 percent of all Medicare payments to be in alternative payment models by 2018.  These goals, according to HHS, will... READ MORE

With the last Sustainable Growth Rate (“SGR”) “patch” set to expire on March 31, 2015, lawmakers on Capitol Hill must soon decide whether to pass another “patch” or to finally tackle the issue of permanent SGR repeal and replacement. Just last week, House Majority Leader Kevin McCarthy (R-CA) and House Ways and Means Committee... READ MORE

On March 9, 2015, Wisconsin became the 25th state to enact Right to Work legislation with Governor Scott Walker signing Senate Bill No. 44 into law.Wisconsin’s Right to Work law “prohibits a person from requiring, as a condition of obtaining or continuing employment, an individual to refrain or resign from membership in a labor organization, to become... READ MORE

Employers that sponsor retirement and health plans subject to the Employee Retirement Income Security Act (“ERISA”) face significant potential fiduciary liability under the law. However, many employers have little or no training for their executives and staff on discharging those fiduciary responsibilities so as to limit that liability. Training can be costly and difficult... READ MORE

Code Section 501(r) and its corresponding regulations will pose significant challenges for tax-exempt hospital organizations in 2015 and beyond.  While operational personnel will shoulder much of the implementation burden, hospital CEOs and board members must have a general understanding of the new requirements to ensure that the compliance efforts proceed on schedule and to... READ MORE

On March 4, 2015, the Centers for Medicare & Medicaid Services (“CMS”) announced a voluntary Self-Referral Disclosure Protocol (“SRDP”) that will allow physician-owned hospitals and rural providers an alternative way to remedy certain issues of noncompliance with the federal Stark Law (“Stark Law”).1  CMS has provided special instructions regarding a voluntary SRDP for physician-owned hospitals... READ MORE

The Fourth District of the Appellate Court of Illinois reaffirmed that claims by a physician that a hospital’s failure to renew his privileges caused actual and intentional harm to his professional reputation are barred by the Illinois’s Hospital Licensing Act. Only claims alleging an actual or deliberate intention to physically harm the physician or others trump a hospital’s... READ MORE

The Third Circuit Court of Appeals¹ became the third federal appeals court in one week to issue an opinion regarding the False Claims Act’s Public Disclosure Bar.² In a non-precedential opinion, the Third Circuit affirmed the dismissal of a pharmacist’s allegations finding the allegations were based on public information for which the Relator was not... READ MORE