Articles and Blogs

It’s no April Fools’ joke. On April 1, 2019, the Health Resources & Services Administration Office of Pharmacy Affairs (“HRSA”) unveiled a long-awaited website that gives providers participating in the 340B drug pricing program (“340B Program”) direct access to information about the maximum amounts that pharmaceutical companies may charge for certain drugs. This moves... READ MORE

In a previous article, we reported on new billing edits that CMS is implementing, which will Return to Provider any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare-enrolled location identified in Provider Enrollment, Chain and Ownership System (“PECOS”). Those edits were scheduled to be activated... READ MORE

Presidential Budget for 2020 Proposes Major Health Care Cuts President Trump released his administration’s fiscal year 2020 budget this week. While this proposal stands little chance of being implemented in its entirety, it is a good indicator of where the administration’s priorities stand for the next year, and some of the provisions, especially those... READ MORE

On March 5, 2019, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum titled “April 2019 Improvements to Nursing Home Compare and the Five-Star Rating System” (“Memorandum”). In the Memorandum, the Centers for Medicare & Medicaid Services (“CMS”) announced the end of the freeze on health inspection star ratings and added quality... READ MORE

On March 5, 2019, the Center for Clinical Standards and Quality/Survey & Certification Group released a memorandum titled “Revisions to Appendix Q, Guidance on Immediate Jeopardy” (“Memorandum”). The Memorandum’s revisions create a “Core Appendix Q” that will be used by surveyors of all provider and supplier types in determining when to cite immediate jeopardy.... READ MORE

Location, location, location – this will be the focus of a Medicare hospital claims processing requirement. Starting in April 2019, CMS will activate billing edits that will Return to Provider (“RTP”) any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare enrolled location identified in Provider... READ MORE

House Democrats Unveil Single-Payor Legislation House Democrats introduced sweeping “Medicare for All” legislation, providing the most detailed plan to overhaul the current health care system by enrolling all U.S. residents in a single-payor, government-run health plan. It would cover a more expansive set of benefits than the current Medicare program and restructure payment for... READ MORE

Government Funded After Congress Borders on Another Shutdown Congressional negotiators have reached an agreement on a funding deal that avoids another partial government shutdown that would have occurred at midnight tonight. The measure would fund nine out of fifteen federal departments through September 30, 2019. President Trump is expected to sign the legislation into... READ MORE

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

HHS Previews 2019 Regulatory Agenda At a symposium on Tuesday, Deputy HHS Secretary Eric Hargan and CMS Administrator Seema Verma outlined the administration’s health care strategy for 2019, which includes advancing the use of technology, adjusting payments in rural areas and testing new ways to reward high-quality care and reforms to the Stark and... READ MORE