Articles and Blogs

Today, November 30, 2011, the Centers for Medicare and Medicaid Services (“CMS”) held a Special Open Door Forum to announce the Part A to Part B Rebilling Demonstration Project (“Rebilling Demonstration”).  As described in greater detail below, in exchange for waiving certain appeal rights, Medicare hospitals that participate in the Rebilling Demonstration will be... READ MORE

Many Durable Medical Equipment, Prosthetics, Orthotics and Supplies (“DMEPOS”) suppliers are ramping up for Round 2 Competitive Bidding but not all are aware of the implications of this program or if they need to participate in this program.  This alert is intended to answer some frequently asked questions about Round 2 Competitive Bidding. How... READ MORE

On September 14, 2011, the Internal Revenue Service (“IRS”) released new, taxpayer friendly guidance concerning the tax treatment of employer-provided cell phones.  This guidance allows employers to provide cell phones to their employees, either directly or through reimbursement of employees’ cell phone expenses, on a tax-free basis without burdensome recordkeeping requirements so long as... READ MORE

September was a noteworthy month for developments pertaining to worker classification issues.  Most notably, the IRS announced a new program that provides partial relief from federal employment taxes for eligible employers that agree to prospectively treat one or more classes of workers as employees.  This new program, known as the Voluntary Classification Settlement Program,... READ MORE

Executive Summary On October 24, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released a final rule (“Final Rule”) revising the Patient Rights Conditions for Coverage (“CfCs”) for ambulatory surgical centers (“ASCs”).  Effective on December 23, 2011, ASCs will be permitted to provide the patient, the patient’s representative or the patient’s surrogate, patient... READ MORE

The July 2011 version of the CMS-855A, Medicare Enrollment Application (the “855A”) contains new disclosure requirements arising from risk screening criteria found in the Affordable Care Act (the “Act”). These reporting requirements apply not only to applications for new providers enrolling in the Medicare program, but to existing providers that will be required, under... READ MORE

The Department of Health and Human Services by the end of the year is expected to publish its final regulations implementing changes to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) arising from the Health Information Technology for Economic and Clinical Health Act (“HITECH”).  With these regulations pending and a trend toward increasing... READ MORE

Executive Summary In a flurry of regulatory activity aimed at improving efficiencies in health care delivery, on October 24, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued, among other rules1, a proposed rule to eliminate anachronistic and burdensome regulations (“Proposed Rule”).   The Proposed Rule applies to a variety of health care providers. ... READ MORE

The Indiana Office of Medicaid Policy and Planning (“OMPP”) has released a revised prior authorization policy for early refills of prescriptions.  The change will be effective December 1, 2011 and requires that at least 85% of a prescription claim’s days transpire before subsequent claims or prior authorizations can be approved.  This is a change... READ MORE

On November 3, 2011, GlaxoSmithKline (“GSK”) announced an agreement in principle with the U.S. government for the largest settlement to date to conclude ongoing government investigations against a pharmaceutical company marketing products in the U.S.  The $3 billion settlement against GSK, the world’s fourth largest pharmaceutical company, should be finalized in 2012 and is... READ MORE