Articles and Blogs

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... READ MORE

“Incident to” billing is a significant False Claims Act risk for Medicare and Medicaid providers. A new proposed rule will change how physicians and physician practices are supposed to bill for services provided in their offices. CMS Proposal to Limit Incident to Billing This week CMS released the proposed Medicare Physician Fee Schedule Rule... READ MORE

Written by David B. Honig and Steven H. Pratt. On February 2, the Sixth Circuit Court of Appeals ruled on a case from the Southern District of Ohio, US ex rel American Systems Consulting, Inc. v Mantech Advanced Systems International. At issue was whether a court may determine whether a knowingly false statement in a proposal for... READ MORE

On May 16, 2014, CMS issued a Survey and Certification Transmittal (“Transmittal”) to the state survey agency directors providing infomation on how Medicare and Medicaid certifed long-term care facilities may obtain an extension of time for the installation of automatic sprinkler sytems.  The Transmittal sets forth the procedures on how a nursing home may seek an... READ MORE

President Obama introduced his fiscal year (“FY”) 2015 budget yesterday, and there are many proposed cuts to post-acute care providers.  Some of the highlights include a number of bundled payment initiatives, a $100 co-pay for home health patients not discharged from a hospital and re-admission penalties for skilled nursing facilities (“SNFs”) with high hospital... READ MORE

Effective January 31, 2014, the Centers for Medicare & Medicaid Services (“CMS”) has issued a temporary moratoria for the enrollment of home health agencies in Fort Lauderdale, Florida; Detroit, Michigan; Dallas, Texas; and Houston, Texas.  CMS also announced it is extending the current enrollment moratoria in Chicago, Illinois and Miami, Florida for another six... READ MORE

Prior to the government shutdown, Representative Jim McDermott of Washington introduced a bill that would end the hospital inpatient requirement for skilled nursing facility (“SNF”) coverage.   READ MORE

On August 13, 2013, all nursing facilities participating in the Medicare and Medicaid programs were required to be in compliance with the automatic sprinkler systems’ regulation that was published in a final rule on August 13, 2008. The regulation provided a five-year phase-in program to allow long-term care facilities (“Facilities”) to achieve compliance by... READ MORE

On August 2, 2013, the Centers for Medicare and Medicaid Services (“CMS”) issued an update to the State Operations Manual (“SOM”) regarding the process for notification of a facility closure.  The updates to the SOM are the result of a final rule published in the Federal Register on March 19, 2013 and can be... READ MORE

One of the main admission requirements for a skilled stay in a skilled nursing facility (“SNF”) is a three-day qualifying stay in an inpatient hospital.  In response to a question discussed on a recent Open Door Forum, the Centers for Medicare & Medicaid Services (“CMS”) released a memorandum discussing if a stay in a... READ MORE