Articles and Blogs

The American Hospital Association (“AHA”) released a “homestretch” checklist to help hospitals verify that they are ready for the transition from ICD-9 to ICD-10.  The AHA recommends checking internal systems, verifying external partner readiness and consideration of financial protections.  This includes verification that their software applications have been appropriately updated to accommodate the transition.  The checklist…Read More

In a judicial opinion certain to rock the provider world, Judge Edgardo Ramos of the Federal District Court for the Southern District of New York denied a New York Health System’s (“Health System”) motion to dismiss the U.S.’s and New York State’s complaints in intervention under the federal False Claims Act (“FCA”) and state counterpart,…Read More

Executive Summary Earlier this year, the Department of Health and Human Services (“HHS”) announced significant changes to Medicare by setting quantitative goals for its value-based payment programs. This payment reform is not only accelerating the shift away from fee-for-service toward a value-based system but also driving fundamental changes in how care is delivered. Health care…Read More

On August 6, CMS published an updated “Place of Service Codes for Professional Claims” that includes a new Place of Service (“POS”) 19 for “Off-Campus Outpatient Hospital” and a revised POS 22 for “On-Campus Outpatient Hospital.” The descriptions are as follows:

Congress Begins August Recess On August 5, Senate leaders determined that no further action was likely on pending legislative matters and called for the start of the August recess break.  Prior to adjourning, the Senate passed amended measures seeking an adjustment of the management of electronic health records on patient encounters in ambulatory surgical centers…Read More

On July 27, the Senate unanimously approved the Notice of Observation Treatment and Implication for Care Eligibility (“NOTICE”) Act, which was earlier approved unanimously by the House of Representatives in March. The bipartisan legislation will proceed to the President and is expected to be signed into law. The NOTICE Act makes changes to hospital requirements…Read More

Hospital Payment Bills Introduced in the House On July 29, the House Ways and Means Committee introduced a number of bills seeking to reform Medicare’s payment to hospitals. The bills are said to be part of a larger hospital-related bill that will be introduced this fall. Health Subcommittee Chairman Kevin Brady (R-TX) introduced H.R. 3292,…Read More

Executive Summary CMS recently published its CY 2016 Hospital OPPS and ASC Proposed Rule in which it proposes to create a new exception under the 2-Midnight Rule. The 2-Midnight Rule provides that hospital inpatient admissions are generally payable under Medicare Part A if the admitting physician (or other admitting practitioner) expected the patient to require…Read More

On July 30, 1965, President Lyndon B. Johnson signed into law what we now know as the Medicare and Medicaid programs.  They came into being after a long political gestation period that can be traced back to President Theodore Roosevelt’s proposals for a national health insurance system in 1912 and President Harry Truman’s 1948 bid for…Read More

Employees in the private sector have a legally protected right to engage in concerted activity for their mutual aid and protection. The NLRB has interpreted this to mean that employees have the right to discuss among themselves ongoing confidential investigations initiated by the employer in response to workplace complaints. An employer that requires or even…Read More