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Sep 28, 2018

Continued Uncertainty of Provider-Based Status in Space Sharing Arrangements

Space sharing and co-location arrangements have been popular service delivery models for hospitals and independent physician practices.  These arrangements enhance patient convenience, improve continuity of care and present cost sharing benefits to the parties involved.  However, Medicare rules related to hospital provider-based department status and the Pennsylvania Department of Health (DOH) Guidance Regarding Hospital Outpatient Department – Shared Space arrangements have severely limited what space sharing arrangements will continue to qualify under Medicare’s Hospital Outpatient Department (HOPD) billing rules.» Read More

Sep 18, 2018

Billing Pennsylvania Medicaid for Nursing Facility Residents’ Medicare Part B Copays Ruled as Impermissible Balance Billing

The Pennsylvania Commonwealth Court has upheld an order of the Department of Human Services (“DHS”) disallowing a nursing facility’s practice of billing Medicaid for Medicare cost-sharing amounts of dual eligible (Medicare and Medicaid) residents.  See Mulberry Square Elder Care v. D.H.S.» Read More

Aug 31, 2018

ACOs Generate $313 Million in Savings to CMS

The Centers for Medicare & Medicaid Services (CMS) released new data showing that it made a $313 million gain from the Medicare Shared Savings Program in 2017.  The 472 Medicare Accountable Care Organizations (ACOs) collectively generated savings of $1 billion and CMS paid $780 million in bonuses to the ACOs.» Read More

Jul 19, 2018

CMS Proposes Overhaul of Billing Rules and Pays for Telehealth

On July 12, 2018, The Centers for Medicare & Medicaid Services (CMS) proposed a major overhaul of the way doctors have billed Medicare for patient visits for two decades. Some of the key provisions in the lengthy proposed rule include:

  • simplifying the billing process to require less documentation that must be submitted by collapsing four separate levels of documentation requirements into one;
  • allowing physicians to use their medical decision making or time spent with the patient to designate the level of patient care needed in lieu of using the traditional evaluation and management codes;
  • paying physicians for certain telemedicine services; and
  • continuing the site-neutral policy that pays off-campus facilities 40% of the outpatient rates for the services they provide to encourage “fairer competition between hospitals and physician practices by promoting greater payment alignment between outpatient care settings.”

If you have any questions concerning the proposed regulations, please contact me at sjarvaweiss@nmmlaw.comRead More

Mar 20, 2018

When Performing Employee Exclusion Checks, Check Both LEIE and the GSA Debarred Individuals List

Health care providers and entities routinely check the Office of Inspector General’s (“OIG”) List of Excluded Individuals and Entities (“LEIE”) prior to employing or entering into a contract with an individual to determine the exclusion status of the potential employee or contractor. » Read More

Mar 07, 2018

Medicare Appeals Backlog – Waiting an Eternity for Your “Day in Court”

Those health care practitioners who have been unfortunate enough to be issued a demand for overpayment in a Medicare Summary Notice (“MSN”) are certain to eventually become aware of the arduous and lengthy process required to appeal such a determination.  A function of the huge backlog of appeals is that health care practitioners are routinely forced to wait several years before finally having their appeals heard by an Administrative Law Judge.  » Read More

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