Articles and Blogs

NATIONAL 2024 outlook: Health IT investment, M&A and AI AMA ‘disappointed’ after Congress leaves physician pay fix out of bill to avert shutdown American Hospital Association: Medicare Advantage denials jump 56% CMS awards second batch of new Medicare-funded residency slots to hospitals CMS issues proposed notice of benefit and payment parameters for 2025 CMS... READ MORE

The United States District Court for the Eastern District of Wisconsin recently issued a decision involving protections for employees whose jobs involve the investigation of fraud. The case, brought under the anti-retaliation provision of the False Claims Act (“FCA”), is available here. Since 2009, the FCA’s anti-retaliation provision,(codified at 31 U.S.C. § 3730(h)(1)), has provided... READ MORE

On November 17, 2023, CMS published its final rule requiring Medicare and Medicaid nursing facilities to provide more detailed ownership and managerial information. The final rule includes new definitions of “private equity company” and “real estate investment trust” for Medicare enrollment purposes. HCA plans to invest $5.3B in already-approved projects in 2024, including freestanding... READ MORE

On November 3, 2023, the Departments of Health and Human Services, Labor, and the Treasury (collectively, “the Departments”) released a proposed rule that would implement significant administrative and technical changes to the No Surprises Act’s (“NSA”) Independent Dispute Resolution (“IDR”) process (the “Proposed Rule”). These changes aim to create a more efficient IDR process... READ MORE

On October 10, 2023, Citrix released security updates for its NetScaler ADC and NetScaler Gateway appliances to remedy a vulnerability dubbed “Citrix Bleed” under CVE-2023-4966. As of October 17, Citrix and the Cybersecurity and Infrastructure Security Agency confirmed that active exploits by threat actors had been observed on unpatched systems. Additionally, cybersecurity firm Mandiant... READ MORE

According to new Consumer Price Index (CPI) data, inflation was flat during the month of October. Experts believe this is evidence that inflation is cooling off. Year-to-date, the CPI index is up 3.2%. The top five markets for development and urban growth in 2024 are Nashville, Phoenix, Dallas, Atlanta and Austin according to a... READ MORE

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. However, CMS also stated that care spanning two midnights is not “presumed” appropriate for an inpatient level of care under... READ MORE

NATIONAL 3 physician shortage numbers making leaders nervous A shortage of hospital pharmacists is on the horizon, leaders say AHA, Others Urge Congress to Reauthorize Health Care Preparedness Law CMS toughens nursing home ownership disclosures in final rule Congress delays Medicare lab payment cuts for one year Demand—and pay—keep growing for nurse practitioners, physician... READ MORE

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. Medical record documentation and employment relationships are key to supporting how services are provided and billed. Although the Centers for Medicare & Medicaid Services (“CMS”) and regulators have... READ MORE

The U.S. Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) recently released updated guidance in its October 2023 Cybersecurity Newsletter emphasizing the importance of sanction policies in maintaining HIPAA compliance. This guidance builds upon a threat brief previously issued in August 2022 by HHS’ Health Sector Cybersecurity Coordination Center (“HC3”).... READ MORE