Articles and Blogs

During yesterday’s Open Door Forum, Jeanette Kranacs, the Director of the Division of Institutional Post-Acute Care for the Centers for Medicare and Medicaid Services (“CMS”) commented that CMS will not be issuing instructions to surveyors on evaluating compliance and ethics programs until the regulations have been promulgated.  CMS was required to have final regulations and various tools in place as of March…Read More

On March 19, 2013, the Centers for Medicare & Medicaid Services’ (“CMS”) Final Rule regarding notification and relocation requirements for closing a long-term care (“LTC”) facility was published in the Federal Register. Under the new requirements, 60 days prior to the closure of an LTC facility, the administrator must provide written notice to the following:

The Medicare Payment Advisory Commission’s (“MedPAC”) recent Report to Congress included a chapter dedicated to skilled nursing facilities (“SNFs”), which MedPAC reports received $31 billion in Medicare reimbursement in 2011.  Recently, SNFs have been under pressure from repeated reimbursement cuts; however, MedPAC’s analysis states that SNF reimbursement is adequate.  

In Laska v. General Casualty Company of Wisconsin, No. 2010AP2410, slip op. (WI App Mar. 14, 2013), the Wisconsin Court of Appeals held that charitable hospitals may, instead of billing Medicare for treatment of a patient, pursue payment by filing a statutory lien against any tort claims and any settlement or judgment resulting from the…Read More

Executive Summary On March 13, 2013, CMS concurrently released an immediately effective administrative ruling (“CMS Ruling 1455-R” or “Ruling”) and a proposed rule (“Proposed Rule”) reversing CMS policy precluding hospitals from billing on an outpatient basis for inpatient services denied payment on grounds the services should have been provided on an outpatient basis.  Under the…Read More

The Medicare Payment Advisory Commission’s (“MedPAC”) March 25th Report to Congress outlines inefficiencies they believe exist in the post-acute world and lead to excessive Medicare payments to providers. MedPAC recommendations include Congress evaluate post-acute provider reimbursement and encourage use of the lowest cost mix of services necessary to achieve the best outcomes.

Governmental and nonprofit health care providers may begin applying for funding under the Federal Communications Commission Rural Health Care Program on Monday, April 8 for funding year 2013 (July 1, 2013 – June 30, 2014). The Rural Health Care program provides funding to governmental and nonprofit eligible health care providers for telecommunications services, including broadband, necessary for…Read More

On October 1, 2012, the Centers for Medicare and Medicaid Services (“CMS”) began withholding 1% of hospital Medicare reimbursement payments as a part of the Value-Based Purchasing (“VBP”) program. The withheld amount will increase 0.25% each fiscal year until it is capped at 2% for FY 2017. Under the VBP program, hospitals compete with one another…Read More

CMS Releases Part B Inpatient Billing Proposed Rule and Administrator’s Ruling On March 13, CMS released an administrative ruling and a proposed rule allowing Medicare to pay for additional hospital inpatient services under Medicare Part B. Specifically, the proposed rule would allow additional Part B payment when a Medicare Part A claim is denied because the beneficiary should have been…Read More

The recent amendments to the False Claims Act, the Fraud Enforcement Recovery Act of 2009 (“FERA”), the Patient Protection and Affordable Care Act of 2010 (“PPACA”), and the Dodd-Frank Wall Street Reform and Consumer Protection Act (“Dodd-Frank”) continue to generate new rules and guidance. Effective 2007, Congress created incentives for States to pass and enforce mirror FCA statutes that…Read More