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Highlights The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2025 Revisions to Payment Policies under the Physician Fee Schedule (MPFS) and Other Revisions to [...]

The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute). The result [...]

On Friday, November 1, 2024, the Center for Medicare & Medicaid Services (CMS) issued the display copy of the final rule interpreting the 60-day Refund Rule for Medicare Parts A/B [...]

The 60-day Refund Rule, created by the 2010 Affordable Care Act, requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. See Section 1128J(d) [...]

Last month, the U.S. Department of Health and Human Services Office of Inspector ('OIG') released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations ('MAOs') [...]

Introduction More than 900 hospitals across the United States are approaching a Centers for Medicare & Medicaid Services (CMS)-imposed deadline to report overpayments from the removal (explant) of defective cardiac [...]

On December 3, 2020, MEDPAC reviewed hospice data from 2019, noting these key metrics: Medicare payments grew just under 10% to $20.9 billion; Hospices served 1.6 million patients, including 51% [...]

Elias Matsakis is a Partner in Holland & Knight's Chicago office Co-authored by Mya Strauss Centers for Medicare & Medicaid Services (CMS) has published the list of 832 Acute Care [...]

On August 9, 2018, CMS introduced a proposed rule that would substantially overhaul the Medicare Shared Savings Program (MSSP), requiring Accountable Care Organizations (ACOs) that participate in the MSSP to [...]

On July 12, 2018, the Centers for Medicare & Medicaid Services ('CMS') issued a proposed rule that includes proposals to update payment policies and rates for services furnished under the [...]

Some very good news for the telehealth community can be found amidst the more than 1,400 pages of the proposed Medicare Physician Fee Schedule for 2019 ('Proposed Rule') issued by [...]

On Monday, CMS published a number of policies changing the dynamics of the individual market, including the Benefit and Payment Parameters for 2019 Final Rule, guidance on hardship exemptions, and [...]

The Massachusetts Department of Unemployment Assistance (DUA) has begun assessing Employer Medical Assistance Contribution (EMAC) supplemental payments for the first quarter. This post proposes a grounds for appealing DUA determinations [...]

On November 30, the Centers for Medicare & Medicaid Services (CMS) announced that it published a final rule (CMS-5524-F and IFC) officially canceling mandatory hip fracture and cardiac bundled payment [...]

An article in Bloomberg BNA's Pharmaceutical Law & Industry Report and other publications, 'Medicare Releases Drug, Device Open Payments Data,' discussed the recent annual release of data under the Open [...]

In 2016, an estimated $41.1 billion in improper Medicare fee-for-services payments were made to providers. The Centers for Medicare & Medicaid Services (CMS) believes that provider education plays an important [...]

The 21st Century Cures Act (H.R. 34) was recently overwhelmingly approved by both houses of Congress and reportedly will be signed into law by President Obama on December 13, 2016. [...]

CMS has released the final 2017 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes, including determinations regarding whether CMS will use crosswalking or gapfilling [...]

Market Based Payment for Clinical Diagnostic Laboratory Tests Summary On June 17, 2016 the Centers of Medicare & Medicaid Services (CMS) issued the long awaited Medicare Clinical Diagnostic Laboratory Tests [...]

The long awaited Final Rule on return of Medicare overpayments (Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) took effect on March 14, 2016. The Final [...]

Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program [...]

The Centers for Medicare and Medicaid Services (CMS) recently issued its final rule for Reporting and Returning of Overpayments (Final Rule). The Final Rule implements section 1128J(d) of the Social [...]

The Patient Protection and Affordable Care Act ('PPACA'), signed into law on March 23, 2010, included a provision (the 'Report and Refund Mandate'), broadly requiring health care providers, suppliers, Part [...]