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Permanent changes finally coming to telehealth

Mackenzie Wallace April 8, 2021
A woman talking to a doctor via a telehealth appointment

CMS has finalized a rule that expands Medicare coverage for telehealth services. This final rule, along with other new rules and waivers by the federal government, state governments and private payors, has significantly expanded access to and coverage of virtual health care services in response to the public health emergency. READ MORE

CMS draft guidance on co-location arrangements: What hospitals and health care entities need to know

Milada Goturi May 29, 2019
health care waiting room

On May 3, 2019, CMS issued long-awaited draft guidance addressing co-location arrangements, providing some clarification on how a hospital can share space, services, staff and emergency services and still demonstrate independent compliance with the Medicare Conditions of Participation for hospitals (“COPs”). READ MORE

CMS seeks public comment on potential Stark Law modifications

August 2, 2018
gavel and stethoscope

The broad scope of CMS’s recent Request for Information gives health care providers an opportunity to voice their concerns on a variety of Stark Law provisions, and may demonstrate an interest within the administration to modify the regulations implementing this statute. READ MORE

CMS announces new voluntary episode-payment program: BPCI Advanced

January 10, 2018
Medical money

On Jan. 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary episode-payment program, Bundled Payments for Care Improvement Advanced, which allows health care providers to accept risk for the cost of care associated with a clinical episode “based on how successfully they manage resources and total costs.” READ MORE

CMS revises CJR program, cancels cardiac bundles

August 22, 2017
Medical money

In August, CMS issued a proposed rule seeking to reduce mandatory participation requirements in the CJR program and eliminate the episode payment models and CR incentive payment model before their scheduled effective date. READ MORE

CMS finalizes additional delay for episodic payment programs

June 9, 2017
digital caduceus symbol

After earlier delays, the Centers for Medicare and Medicaid Services has set the start date for cardiac episode payment models and revisions to the Comprehensive Care for Joint Replacement to Jan. 1, 2018. READ MORE

CMS changes the SRDP process effective June 1, 2017

June 2, 2017
Health Law Checkup_default blog

If you are in the process of drafting a Self-Referral Disclosure Protocol submission, you must use CMS' new SRDP forms or risk the agency not accepting the disclosure into the protocol. READ MORE

Mandatory arbitration agreements in long-term care facilities: A thing of the past...or not?

Nicole Jobe November 14, 2016
Long-Term Care

At the end of November, CMS will prohibit long-term care facilities from using pre-dispute arbitration agreements and only allow arbitration when a dispute arises on a voluntary basis. But a federal judge in Mississippi has already granted a request to bar CMS from implementing the rule. READ MORE

8 tips for engaging ACO boards to meet requirements in the Final Waivers

May 19, 2016
Health Law Checkup_default blog

Given the increased emphasis on the ACO governing body’s work in the Final Waivers, it is paramount that ACO Boards work thoughtfully through this evaluative process, documenting its consideration, analysis, and conclusions in formal Board minutes. READ MORE

Final Rule on refund of Medicare overpayments: Key requirements to know

Milada Goturi March 18, 2016

The three key requirements that the Final Rule clarified and which all providers participating in Medicare Part A and Part B must know are: (a) when is an overpayment identified by a provider, (b) what is the required lookback period for returning overpayment, and (c) what process must be used to refund an overpayment. READ MORE

Record-breaking FCA settlements underscore importance of Stark Law compliance

November 3, 2015
Health Law Checkup_default blog

With the continued focus of the government on investigating and prosecuting matters involving compliance with the Stark Law, health care systems entering into compensation arrangements with referring physicians must have robust processes in place to ensure that the compensation arrangements – at the time that they are structured and during the course of the arrangement – don’t run afoul of the Stark Law. READ MORE

Comprehensive Care for Joint Replacement: CMS adopts mandatory approach to payment reform

August 27, 2015

Hospitals affected by the CCJR model proposal will need to address a number of opportunities and challenges rather quickly. READ MORE

CMS establishes Health Care Payment Learning and Action Network

April 13, 2015

HCPLAN is intended, in part, to “identify areas of agreement” for new payment models and reporting methods. More generally, it would seem, HCPLAN has the challenge of working to define value for healthcare delivery, to determine how to measure value and then how to pay for that value. This is no small task/ READ MORE

Timeline tightens for provider, supplier responses to MAC and ZPIC requests starting April 6, 2015

March 25, 2015
Health Law Checkup_default blog

Effective April 6, 2015, in response to a pre-payment review and additional documentation request issued by a MAC or ZPIC, providers and suppliers will be limited to a 45 calendar day timeframe to produce the requested documentation and should no longer have any expectation that a request for an extension of time will be granted. READ MORE

An update on open payments

May 8, 2014
Health Law Checkup_default blog

Since our report last week, “Next steps under open payments,” the Centers for Medicare & Medicaid Services (“CMS”) has released additional information on the time frame for registration on CMS’ Enterprise Portal for physicians and teaching hospitals. READ MORE

Next steps under open payments

Joy Harris Hennessy April 30, 2014

As manufacturers and group purchasing organizations (“GPOs”) get ready for Phase 2 of Open Payments (formerly, the Physician Payments Sunshine Act), physicians and teaching hospitals should be aware that a voluntary registration process to enable them to review data submitted by manufacturers and GPOs through Open Payments will soon follow. READ MORE