Articles and Blogs

Just three days before its effective date, the United States Court of Appeals for the District of Columbia affirmed the legality of the Department of Health and Human Services (“HHS”) price transparency rule requiring hospitals to publicly disclose the prices they charge for items and services, including their negotiated reimbursement rates with third-party payers... READ MORE

On December 22, 2020, Congress passed a government funding deal, which includes a long-awaited federal fix for “surprise billing.” Most of the new requirements take effect with plan years beginning January 1, 2022, and they apply to group health plans (including self-insured plans) and health insurance issuers of group and individual plans. The statute... READ MORE

States like Indiana, Connecticut and Maine are offering to pay nursing homes a higher per diem for COVID-19 presumptive residents or a higher percentage reimbursement rate if a nursing home qualifies as a “COVID-19 ready” facility, as discussed in our recent article here. As nursing homes assess, plan for and take actions to qualify... READ MORE

On May 11, 2020, CMS released the 2021 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Among other changes in the Proposed Rule, CMS is adopting updated labor market area delineations to take effect on October 1, 2020. Hospitals should review whether they are in a county that is affected by the updated... READ MORE

On April 30, 2020, CMS published guidance in a second Interim Final Rule (“IFR”) addressing regulatory flexibilities available to hospitals to bill for hospital/critical access hospital outpatient therapeutic services on the UB-04 when such services are furnished in a temporary expansion location (including a beneficiary’s home) during the COVID-19 public health emergency (“PHE”). This... READ MORE

On April 23, the Department of Health and Human Services (“HHS”) outlined the basic framework for a new program to reimburse hospitals and other providers and suppliers for services provided to uninsured COVID-19 patients (for purposes of this article we refer to both providers and suppliers as “providers”). The framework for the program is... READ MORE

The Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), which became law on March 27, 2020, requires all providers of COVID-19 diagnostic testing to publish on their public websites the cash price for such testing during the declared emergency.[1] Doing so also allows health care providers to set a reimbursement rate with out-of-network... READ MORE

On March 25, 2020, the Senate passed the Coronavirus Aid, Relief, and Economic Security Act (H.R. 748) (“CARES Act” or “Act”). The CARES Act contains numerous provisions aimed at the response to the Coronavirus or COVID-19 pandemic, including $100 billion in reimbursement to hospitals and other health care entities for COVID-19-related expenses and lost... READ MORE

On February 11, 2020, the U.S. Court of Appeals for the District of Columbia (D.C.) Circuit upheld the decision of a lower court granting summary judgment in favor of the Secretary of the Department of Health and Human Services (“HHS”) in a wage index calculation Medicare reimbursement case. The Court held that the Secretary’s... READ MORE

Recently, hospitals operating nursing and other allied health (“N&AH”) education programs have experienced increased scrutiny during Medicare Administrative Contractor (“MAC”) audits concerning their receipt of pass-through cost reimbursement. In many instances, MACs have begun disallowing or reclassifying costs that N&AH education programs received without issue for many years. Oftentimes the MACs are citing new... READ MORE