Tag Archives: CMS
CMS Issues Section 1135 Waivers for New York and New Jersey
The Centers for Medicare and Medicaid Services (CMS) approved waivers for New York and New Jersey under Section 1135 of the Social Security Act. The waivers ease certain legal requirements on healthcare providers who are serving those impacted by Sandy. … Continue reading
False Claims Act: Payment vs. Participation Regulations
In U.S. ex rel. Williams v. Renal Care Group, Inc. (Case No. 11-5779) (October 5, 2012), the Sixth Circuit Court of Appeals reversed a grant of summary judgment in favor of the United States on two main False Claims Act … Continue reading
New York State Allegedly Overbilled $15 Billion for State-Operated Facilities for Developmentally Disabled
On May 17, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report that found Medicaid overpayments to New York State-operated developmental centers. The OIG concluded that, in 2009, State-operated facilities for the developmentally disabled … Continue reading
HIPAA: Conversion to Version 5010
As of January 1, 2012, all healthcare providers were required to transition from version 4010/4010A to version 5010 standards for submitting electronic transactions, and the failure to comply may result in claim denials or a government investigation. CMS has repeatedly … Continue reading
OIG Releases Report on Medicaid Rates for New York State-Operated Developmental Centers
The Office of Inspector General (“OIG”) released a report yesterday based on its review of the reimbursement rates for New York State-operated developmental centers. The report found that the Medicaid daily rate for state-operated developmental centers was inflated, and that … Continue reading
HHS Selects 32 Organizations for the Pioneer ACO Model
The U.S. Department of Health and Human Services (HHS) recently selected 32 Accountable Care Organizations (ACOs) to participate in the Pioneer ACO Model designed by the CMS Innovative Center to test the impact of several innovative payment arrangements to support … Continue reading
CMS Publishes Regulations on Accountable Care Organizations
Today, CMS published its final rule implementing the part of the Affordable Care Act governing Accountable Care Organizations (ACOs). A copy of the rule is available here. The portion of the Affordable Care Act implemented under this new rule requires … Continue reading
CMS Officially Withdraws Physician Signature Requirement
As we previously reported here and here, it was just a matter of time before the Center for Medicare & Medicaid Services (CMS) officially withdrew its rule requiring physician signatures on all laboratory requisitions for clinical diagnostic laboratory tests paid … Continue reading
Federal Decision Shows Inability to Rely upon CMS Approval
A recent decision by the U.S. District Court for the Middle District of Tennessee has significant implications on provider arrangements structured in reliance on the knowledge and approval of the Centers for Medicare and Medicaid Services (CMS). In U.S. ex … Continue reading
CMS Proposes Rule to Make Medicare Data Available for Public Reports About Providers
The Patient Protection and Affordable Care Act (“PPACA”) requires that “standardized extracts” of Medicare claims data be made available to “qualified entities” in connection with their preparation of reports evaluating the performance of providers. Since this information is now “required … Continue reading
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