Tag Archives: Medicare

Payers Embracing Telemedicine Cost Savings, Ramping Up Reimbursement in 2016

Often considered the primary obstacle to telemedicine implementation, reimbursement changes are now better viewed as one of the most prominent drivers of telemedicine expansion. Payers are finally beginning to realize what many providers have known for some time – telemedicine brings cost savings and improved patient-member satisfaction.… Continue reading this entry

Five Telemedicine Trends Transforming Health Care in 2016

Telemedicine is a key component in the health care industry shift to value-based care as a way to generate additional revenue, cut costs and enhance patient satisfaction. It is expected that the global telemedicine market will expand at a compound annual growth rate of 14.3 percent through 2020, eventually reaching $36.2 billion, as compared to … Continue reading this entry

Budget Law Moves Towards Site-Neutral Medicare Payments; Join Foley for a Discussion on November 13

The recently enacted Bipartisan Budget Act (P. L. 114-74) included a provision that will significantly alter the future of hospital-based outpatient care. The provision, Section 603, will exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as determined by Medicare’s provider-based standards, unless it is a “dedicated emergency … Continue reading this entry

Budget Bill Aims to Kill Any New Off-Campus Provider-Based Facilities

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers
Legislation being drafted as part of a budget deal between members of Congress and the White House includes language that will significantly alter the future of hospital-based outpatient care. The “discussion draft” of the bipartisan budget agreement would exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as … Continue reading this entry

Clinical Laboratories: Proposed Rule Implements Requirements for Reporting and Payment Based on Private Payer Rates

As required by a 2014 statute, CMS has issued proposed regulations (Proposed Rule) implementing new requirements for laboratory reporting of, and eventually basing Medicare payment on, rates for clinical laboratory services paid by private payers. When finalized, the rules will appear in 42 C.F.R. Part 414, primarily in Subpart G. Comments on the Proposed Rule … Continue reading this entry

Medicare Telehealth Services in Puerto Rico

As U.S. health care providers continue to use telehealth, telemedicine, and virtual care services to expand their services and geographic footprint overseas, they are beginning to ask whether or not Medicare will cover telehealth services provided to Puerto Rico. Not only is Puerto Rico classified as a Medicare coverage location, but Puerto Rico contains geographic … Continue reading this entry

The Telehealth Top 10 for 2015

Telemedicine
Telehealth continues to be an innovative alternative to traditional brick-and-mortar medicine. The number of providers offering telehealth services is rapidly increasing and states are enacting laws requiring health plans to cover telehealth services and telehealth technology at a brisk pace. Listed below are the top ten key issues that providers of telehealth services should keep … Continue reading this entry

Omnibus 340B Guidance Raises New Issues for Covered Entities

The Department of Health and Human Services (HHS) released its proposed 340B Drug Pricing Program Omnibus Guidance (Omnibus Guidance) on August 28, 2015. The Omnibus Guidance offers comprehensive – and, in some cases, new – guidance for 340B Drug Pricing Program (340B Program) covered entities (including providers such as disproportionate share hospitals, critical access hospitals, … Continue reading this entry

Will the TELE-MED Act of 2015 Really Change Licensure Rules?

Congress is reviewing legislation designed to permit telemedicine providers to treat Medicare patients across state lines without the need for separate state licensure. The Telemedicine for Medicare Act of 2015 (S. 1778 and H.R. 3081), known as the TELE-MED Act of 2015, is sponsored by Representative Devin Nunes (R-CA), 15 Republicans and 9 Democrats in … Continue reading this entry

Fasten Your Seat Belts: District Court Says “Failure to Act Quickly Enough” May Violate 60-Day Refund Rule

A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which both the federal government and the State of New York have intervened. As important to this discussion, the … Continue reading this entry

4 Ways Medicare and Medicaid Have Changed the Health Care Industry

It’s a bizarre program that is absolutely essential to American healthcare. That is the opinion of Theodore Marmor, professor of public policy at Yale and author of the book, The Politics of Medicare. Whether you agree with him or not, it is difficult to deny the influence of Medicare and Medicaid on the health care … Continue reading this entry

Congress Wows With Medicare Telehealth Parity Act of 2015, But Will It Succeed?

Rep. Mike Thompson (D-CA) and co-sponsors Rep. Gregg Harper (R-MS), Rep. Diane Black (R-TN), and Rep. Peter Welch (D-VT) announced, on July 7, 2015, the introduction of the Medicare Telehealth Parity Act of 2015, forward-looking, bi-partisan legislation intended to modernize the way Medicare pays for telehealth services. Containing three implementation phases over a four year … Continue reading this entry

What to Expect From HHS-OIG's New Litigation Team

CMS Releases Medicare Part B Supplier Billing and Payment Data
The Office of Inspector General at the U.S. Department of Health and Human Services (“HHS-OIG”) announced, on June 30, 2015 (during a health care conference), the creation of a new litigation team that will focus solely on levying fraud-based civil money penalties and excluding providers from Medicare and Medicaid for committing fraud. The point is to … Continue reading this entry

Physicians Face Increased Anti-Kickback Enforcement Focus

It appears that the Office of Inspector General (“OIG”) now has physicians squarely in the crosshairs of one of its most powerful enforcement tools: the Anti-Kickback Statute (“AKS”). The AKS is a criminal statute with stiff penalties. It prohibits the offer or payment of anything of value with the intent to induce the referral of … Continue reading this entry

Medicare Penalties and Bonuses for Meaningful Use of EHRs Revamped as Part of the "Doc Fix" Bill

The American Health Lawyers Association last week published an analysis of the changes to the Medicare penalties and bonus payments for Eligible Professionals under the electronic health records meaningful use program under the Doc-Fix bill.  The changes restructure the penalties and bonus payments under the quality framework established by the Merit-based Incentive Payment System.  The … Continue reading this entry

Insurer Wrongfully Passed Sequestration Cuts Through to Providers

CMS Releases Medicare Part B Supplier Billing and Payment Data
A Pennsylvania judge found, on May 6, 2015, that a Medicare Advantage Plan had no right under its participation agreements to pass CMS sequestration reductions through to participating providers. Judge R. Stanton Wettick Jr. in the Allegheny Court of Common Pleas granted summary judgment to a group of hospitals that sued Highmark Inc. and its affiliate … Continue reading this entry

Court Rules: Standard for Evaluating Reimbursement of Skilled Nursing Medicare Claims Was Material Improvement

CMS Releases Medicare Part B Supplier Billing and Payment Data
A False Claims Act (“FCA”) lawsuit in Georgia was dismissed on March 31, 2015, after a federal district judge ruled that the government’s expert witnesses used the wrong standard to determine whether certain skilled therapy services were reimbursable under Medicare Part A (United States ex rel. Lawson v. Aegis Therapies, Inc., S.D. Ga., No. 2:10-cv-00072-LGW-RSB, … Continue reading this entry

Does the "Doc Fix" Bill Help Telemedicine and Telehealth?

Telemedicine
In a word: yes.  Telemedicine was one of the many beneficiaries of changes introduced by the so-called “doc fix” bill, formally titled the Medicare Access and CHIP Reauthorization Act (H.R. 2). The legislation was passed by Congress on April 15, 2015 and signed into law by the President on April 16, 2015. It introduces sweeping … Continue reading this entry

Senate Vows to Address Medicare Physician Reimbursement Cut in Mid-April

Preparing for the Conversion to ICD-10
The Senate adjourned around 3:30 a.m. Friday, March 27, 2015 without passing legislation to hold off a scheduled 21 percent cut in Medicare physician payment rates. Senate leadership was unable to get all 100 senators to agree to fast track a House-passed bill that would halt the reimbursement cut and transition the Medicare physician payment … Continue reading this entry

House Plans to Vote Thursday on Medicare Physician Payments, CHIP Extension Legislation

Regulatory-Developments
After a decade of short-term actions, congressional leaders are pushing this week to permanently repeal the Sustainable Growth Rate (SGR) formula that governs Medicare physician payment rates, and replace the system with one that values quality outcomes. The SGR formula has called for dramatic cuts every year for the past 10 years, but Congress has … Continue reading this entry

Congressional Leaders Introduce Legislation to Repeal Medicare’s SGR Formula, Increase Physician Reimbursement Rates

A group of bipartisan, bicameral congressional leaders introduced a bill, on March 19, to repeal the Sustainable Growth Rate (SGR) formula that governs Medicare physician payment rates. The formula has called for dramatic payment cuts every year for the past 10 years, but Congress has passed several temporary “patches” over the formula through the years … Continue reading this entry

DME Suppliers, Get More Information on Your Medicare Appeals

A new Office of Medicare Hearings and Appeals (OMHA) website offers intel on reimbursement appeal status, but does little to speed up the appeal process or eliminate the current backlog. It does, however, provide useful documentation, and DME suppliers should consider the impact of the delay on Section 935 interest. OMHA just unveiled a new … Continue reading this entry

OIG Releases Fiscal 2014 Report to Congress

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) released its Semiannual Report to Congress (Report) last week summarizing health care fraud investigation activities for the second half of fiscal year 2014 and the full year’s achievements. OIG reported expected recoveries of over $4.9 billion for fiscal year … Continue reading this entry

CMS Releases Proposed Revised Medicare Shared Savings Program Regulations

This is the first post in Health Care Law Today’s series on the proposed rule. The Centers for Medicare and Medicaid Services released, on December 1, 2014, a proposed rule to revise the Medicare Shared Savings Program (“MSSP”) Accountable Care Organization (“ACO”) Regulations. The proposed rule is expected to be published in the Federal Register on December … Continue reading this entry