Health Care Law Brief

APRIL 12, 2023

79452 (2022)). Part C Reforms Pursuant to the Final Rule, if an MA plan prior authorized an item or service or made a pre-service determination of coverage or payment, the MA plan may not later deny coverage for lack of medical necessity and may not reopen the decision, except for “good cause” (as defined in 42 C.F.R. 405.902).

Medicare 52

Medicare Medicare Overpayment Overpayments 52

AIHC

APRIL 5, 2022

Read Part 1 entitled “ Managing Denials Is Important to Good A/R Hygiene ” posted March 22, 2022, and Part 2 entitled “ Understanding How Payers Deny Claims. Providers may take documentation “short cuts” or feel overwhelmed with implementation of a new EMR (electronic medical record) system and clone or make documentation errors.

Fraud 52

Fraud Medicare Medicare Compliance 52

Hall Render

OCTOBER 7, 2022

Hospitals likely to end 2022 in the red despite August boost, report says. Judge orders Anthem to face lawsuit over alleged Medicare overpayments. Judge rules that HHS must immediately halt unlawful reimbursement cuts to certain 340B hospitals for rest of 2022. Private equity drove 70% of physician medical group deals last year.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40