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Medicare
Hospital Price Transparency Rule in Effect
The Hospital Price Transparency Rule went into effect on January 1, 2021. The Rule requires all hospitals operating within the United States to make public a…
CMS Provides Additional Expansion Opportunities for High Medicaid Physician-Owned Hospitals
Under the Affordable Care Act’s amendments to the Stark Law, a Physician Owned Hospital (POH) cannot expand the aggregate number of operating rooms, procedure rooms or…
Cutting Out the “Middleman”? HHS Resurrects Anti-Rebate Rule for Medicare Part D
[T]he Final Rule will modify the federal health care program’s Anti-Kickback Statute (“AKS”) safe harbors in three key ways: First, it will remove safe harbor protection…
Direct Contracting Model Comes to Medicare
Under the model, healthcare providers — which CMS calls “direct contracting entities,” or DCEs — will competitively bid to manage 100% of the Medicare Part A…
CMS final 2021 physician fee schedule rule
CMS issued the final rule for the 2021 Physician Fee Schedule and doctors will see a conversion factor of $32.41, a decrease of $3.68 from the…
Reimbursement Pressure in Radiation Therapy & Block Lease Arrangements
The finalized Radiation Oncology payment model and the Final CY 2021 Medicare Physician Fee Schedule (“MPFS”) have now been made public. Many in the industry will…
Eleventh Circuit Extends Scope and Time Limits for People Who Sue under the Medicare Secondary Payer Act
Medicare is the Secondary Payor when other insurance is available to pay the claim. However, when the Primary Payor delays payment, Medicare will make a “conditional…