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Post-Acute Compliance Program Update: OIG Recommendations on Medical Director Agreements and Roles

Hall Render

SNF services covered by the Medicare Part A Skilled Nursing Prospective Payment System (PPS) payment are not designated health services (DHS) for purposes of the PSL. Hall Render blog posts and articles are intended for informational purposes only. 1395nn , is often referred to as the Stark Law.

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CMS Proposes Regulations for Rural Emergency Hospital CoPs and CAH Updates; Providers Wait for Clarification on Payment Policies

Hall Render

On June 30, 2022, the Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations (“Proposed Rule”) addressing the Conditions of Participation (“CoPs”) that a provider will need to meet to qualify as an REH. This facility payment will be adjusted each year by the annual hospital market basket update factor.

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New CMS Final Rule Provides Medicare Beneficiaries with Greater Surgical Options and Expands Coverage for Certain Surgical Procedures

Health Law Attorney

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Outpatient Prospective Payment System ( OPPS ) and Ambulatory Surgical Center ( ASC ) Final Rule, which may be accessed here.

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CMS Issues Long-Awaited Medicare Advantage RADV Final Rule

Healthcare Law Blog

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. See also Ratanasen v.

Medicare 105
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Compliance Risks Associated with Outlier Payments 

YouCompli

Price increases can sometimes result in inappropriate outlier payments. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

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CMS Releases Final Rule: Transforming Episode Accountability Model

Hall Render

On August 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the Fiscal Year 2025 Hospital Inpatient Prospective Payment System Final Rule (“Final Rule”), finalizing the proposed Transforming Episode Accountability Model (“TEAM”).

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HHS Publishes Proposed Payments for Rural Emergency Hospitals

Hall Render

REHs may not operate swing beds but may maintain a distinct part skilled nursing facility, which will be paid under the skilled nursing facility prospective payment system. Proposed REH Payments. CMS ultimately proposed a monthly facility payment of $268,294 (just over $3.2 5 Percent OPPS Increase.