Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.

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Healthcare Law Blog

AUGUST 25, 2023

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.

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Overpayments Overpayment Medicaid Medicaid 52

Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs.

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Hall Render

DECEMBER 27, 2023

The $5,000 limit is adjusted annually for inflation and will increase from the 2023 limit of $5,702 to $5,913 beginning January 1, 2024, for the 2024 calendar year. The post Non-Monetary Compensation to Physicians: New Limits for 2024 and Chance to Review 2023 appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.

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Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

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Medicare Medicare Overpayments Overpayment 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The Final Rule is effective June 5, 2023. Parts 417, 422, 423, 455, and 460. 79452 (2022)). 405.902).

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Medicare Medicare Overpayments Overpayment 52

Health Law RX

MARCH 30, 2023

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. As for the final judgment award, on March 17, 2023, the U.S.

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Overpayments Overpayment Fraud Governance 52

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. Challenge in Court On September 1, 2023, Humana Inc. and its subsidiary Humana Benefit Plan of Texas, Inc.

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Medicare Medicare Overpayments Overpayment 52

HIT Consultant

SEPTEMBER 27, 2024

Increasingly rigorous oversight from the Centers for Medicare & Medicaid Services (CMS) and Office of the Inspector General (OIG) are calling for better diligence, planning and administrative oversight for effective risk adjustment. billion in overpayments to MA plans with this new audit methodology over the next ten years.

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Overpayments Overpayment Medicare Medicare 52

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 billion from 2023 through 2032, including extrapolation effects. To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024.

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Overpayments Overpayment Medicare Medicare 52

Hall Render

DECEMBER 6, 2022

non-cash or cash equivalent) compensation to physicians up to an aggregate amount of $489 for calendar year 2023. The $5,000 limit is adjusted annually for inflation and will increase from the 2022 limit of $5,270 to $5,702 beginning January 1, 2023 for the 2023 calendar year. New Exception for Limited Remuneration.

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COVID-19 Hospitals Overpayments Overpayment 40

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements. 2021, January 15).

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Fraud Health Insurance Medicaid Medicaid 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. billion in healthcare fraud judgments and settlements. 2021, January 15).

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Fraud Compliance Health Insurance Medicaid 52

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations.

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COVID-19 Telemedicine Informed Consent Compliance 59

Hall Render

NOVEMBER 25, 2024

Nursing Facility ICPG, together with OIG’s General Compliance Program Guidance (“GCPG”) issued in November 2023, serve as OIG’s updated and centralized source of voluntary compliance program guidance for nursing facilities. It is intended only to assist nursing facilities in evaluating and mitigating their own particular risk areas.

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Hall Render

APRIL 18, 2022

CMS plans to increase Medicare reimbursement for SNFs by 3.9% in fiscal year 2023. reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare. The Department of Health and Human Services extended the Public Health Emergency through July 14, 2022 as a result of the effects of COVID-19.

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Public Health COVID-19 Overpayments Overpayment 40

Hall Render

DECEMBER 11, 2024

The section currently requires OIG to take into account access of beneficiaries to physician services for which payment may be made under Medicare, Medicaid or other federal health care programs in determining whether to impose an exclusion. Information about the LEIE may be found on the OIGs Exclusions page.

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Compliance Licensing Nurses Medicaid 40

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CY 2023 HH Payment Update. CY 2023 National, Standardized 30-Day Period Payment. 1,904.76.

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COVID-19 Payment Systems Medicare Medicare 40

Hall Render

FEBRUARY 23, 2024

billion inpatient hospital tower is moving forward Flu activity ‘very high’ in Ohio, health officials say Christ Hospital closes outpatient behavioral health program OKLAHOMA Ascension St.

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Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

MAY 10, 2024

Vincent Parkview Health’s ASC strategy: 2 updates Indiana hospital margins lag behind nation, with some budgets in the red Report shows Indiana hospitals lost more than $700 million in income in 2023 Two Indiana Hospitals Receive a “D” in Patient Safety Franciscan Health to partner with nonprofits Beacon Health System receives $5.4M

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Nursing Homes Nurses Hospitals Medicaid 40

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Comments on due February 13, 2023. Health Equity in Medicare Advantage. Star Ratings.

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Medicare Medicare Medicaid Medicaid 52

Hall Render

JUNE 30, 2023

in false claims Georgia ranked as one of the worst states for children’s health in 2023 Georgia’s maternal mortality rate still one of the highest in U.S., MedStar Transport Celebrates 40 years of service C. Here’s what you need to know. Georgia physician found liable for $1.1M

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US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

APRIL 19, 2024

George’s hospital nears groundbreaking on new tower after landing millions from state Maryland program for specialist physicians reports initial Medicare savings Why private equity is investing in Maryland’s emergency departments Why the long wait? Can lawmakers do anything about it?

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Nursing Homes Nurses Hospitals Doctors 40

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M

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Nursing Homes US Department of Health and Human Services Nurses Medicaid 40

Hall Render

OCTOBER 7, 2022

Judge orders Anthem to face lawsuit over alleged Medicare overpayments. Delaware retirees protest switch to Medicare Advantage plan. Medicare cuts concern Kentucky home health leaders. URMC CEO to retire in 2023. UNC, Wilson hospitals fix issues that risked Medicare funding; complaints pending at Wilson.

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COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

JANUARY 19, 2024

Workers at another D.C. Bipartisan Ky. hospital company Kansas City Orthopaedic Institute appoints new CEO Kansas City University’s new research center aims to answer: ‘How do we keep people well?’

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Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

NOVEMBER 10, 2023

NATIONAL 340B repayments welcomed but concern remains, hospital group says 4 pieces of legislation fighting to alleviate the physician shortage crisis AHA Files Lawsuit Challenging HHS Guidance on Tracking Technologies AHA says 3.1%

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Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MARCH 22, 2024

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

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Nursing Homes US Department of Health and Human Services Nurses Hospitals 40

Hall Render

MARCH 15, 2024

Children’s National makes first high-level executive appointments under new CEO DC plans to open emergency department in one of its most underserved communities D.C.

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US Department of Health and Human Services Nursing Homes Nurses Hospitals 40