[05/10/19]
Posted on May 10, 2019 in Health Law News
Published by: Hall Render
In keeping with the trends of the commercial market, on April 22, 2019, the Centers for Medicare & Medicaid Services (“CMS”) announced opportunities to participate in new direct contracting models under Medicare’s Part A and Part B fee-for-service program. CMS intends to focus these models particularly on primary care coordination for medically complex and... READ MORE
Tags: Centers for Medicare and Medicaid Services, cms, DCE, Direct Contracting Entities, fee-for-service, PBP, Population Based Payment
[11/09/18]
Posted on November 9, 2018 in Health Law News
Published by: Hall Render
On November 8, 2018, CMS released a letter to clinicians regarding E/M documentation and coding reform. This follows the CY 2019 Medicare Physician Fee Schedule Final Rule intentions to reduce burden on clinicians in furtherance of the agency’s “Patients Over Paperwork” initiative. Effective January 1, 2019, CMS will: Simplify the documentation of history and exam... READ MORE
Tags: 2019 Medicare Physician Fee Schedule Final Rule, Centers for Medicare and Medicaid Services, cms, E/M Documentation, Patients Over Paperwork
[09/28/18]
Posted on September 28, 2018 in Health Law News
Published by: Hall Render
On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“Proposed Rule”). Among many other changes, CMS proposed numerous modifications to the required documentation for evaluation and management (“E/M”) visits in order to alleviate the administrative burden on practitioners and... READ MORE
Tags: 2019 Medicare Physician Fee Schedule, Centers for Medicare and Medicaid Services, cms, CPT Coding, evaluation and management
[09/19/18]
Posted on September 19, 2018 in Health Law News
Published by: Hall Render
On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE
Tags: 340B, Centers for Medicare and Medicaid Services, cms, MA plans, MA-PD plans, Medicare Advantage, Medicare Part B, pharmacy benefit managers, Step Therapy
[08/03/18]
Posted on August 3, 2018 in Health Law News
Published by: Hall Render
On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for the Calendar Year (“CY”) 2019 Medicare Physician Fee Schedule (“MPFS Proposed Rule”). Among many other changes, CMS proposed to maintain payments for certain non-excepted (non-grandfathered) off-campus provider-based hospital departments (“PBDs”) at 40 percent of the Outpatient Prospective Payment System... READ MORE
Tags: Calendar Year 2019 Medicare Physician Fee Schedule, Calendar Year 2019 Outpatient Prospective Payment System, Centers for Medicare and Medicaid Services, cms
[03/15/12]
Posted on March 15, 2012 in False Claims Act Defense
Written by: David B. Honig
Last month the Centers for Medicare & Medicaid Services (CMS) published proposed rules for reporting of overpayments. These proposed rules, if adopted and strictly interpreted, could effectively create a twenty-year statute of limitations under the False Claims Act. READ MORE
Tags: 60 day, Centers for Medicare and Medicaid Services, cfr, cms, CMS–6037–P, Code of Federal Regulations, False Claims Act, FCA, identification, Overpayment, proposed rule, regulation, sixty day, statute of limitations, ten years
