Archive
Reimbursement
No, You Can’t Just Not Take Medicare: What Every Chiropractor Needs to Know
A growing number of chiropractors are moving away from insurance panels in favor of cash-pay practice models built around direct-pay patient relationships. The appeal is understandable—simplified…
“Incident To” Billing Promotes Productivity, But Presents Many Potential Pitfalls
Summary of article from Burr & Forman, by Catherine Kirkland: “Incident to” billing allows physician practices to bill Medicare for non-physician practitioners (NPPs) under a supervising…
HHS Releases Final Part Two Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs
Summary of article from CMS Press Release: The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), has released…
Medicaid Overpayment Audits: What Medical Providers Need to Know
Summary of article from Nelson Mullins, by Gabriel Imperato, Hannah Kays, Melissa Scott: Medicaid overpayment audits ensure program integrity but can be challenging for medical providers.…
Fifth Circuit Grants Motion Relating to New CMA Compensation Rule
Summary of article from Troutman Amin, LLP, by John H. Henson: On July 3, 2024, the US District Court of Northern Texas issued a Memorandum Opinion…
Humana Can Challenge Medicare Clawback Rule
Summary of article from Reuters, by Brendan Pierson: Humana can proceed with its lawsuit against a Biden administration rule that enables Medicare to reclaim overcharges from…
CMS Issues Hospice Proposed Payment Rule
From King & Spalding, by Kate Karpenko: The CMS has issued a proposed rule for fiscal year 2025 to update Medicare hospice payments and aggregate cap…
Fair Market Value and Commercial Reasonableness Considerations Amid CMS Radiopharmaceutical Reimbursement Challenges
From VMG Health, by Carla Zarazua, Preston Edison, and James Tekippe, CFA: Radiopharmaceutical drugs (RPs) are crucial for diagnosing and treating diseases. However, the current pricing…
UnitedHealth Defends Lucrative Billing Tactic in Appeals Court
From Bloomberg Law, by Jacklyn Wille: “Cross-Plan Offsetting” is the practice by an insurer of clawing back benefits it says were overpaid to a provider under…
Texas, Pennsylvania hospitals lose lawsuit challenging Medicare payments
The hospitals said HHS wrongly calculated their Medicare disproportionate share hospital payments for fiscal year 2015, using the wrong data. As a result, the hospitals appealed…