Search for: "Centers for Medicare and Medicaid Services"
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22 Feb 2023, 10:00 pm
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs) and for audits conducted by the Office of Inspector General (OIG), effective for payment year 2018. [read post]
22 Feb 2023, 10:00 pm
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the use of extrapolation to determine overpayments in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs) and for audits conducted by the Office of Inspector General (OIG), effective for payment year 2018. [read post]
22 Feb 2023, 7:17 am
The Centers for Medicare & Medicaid Services (CMS) recently issued a Medicare-related final rule invoking the agency’s statutory authority to promulgate retroactive rules after finding that failure to apply the final rule retroactively would be “contrary to the public interest. [read post]
21 Feb 2023, 4:02 pm
Bryant Legal Group case verdict: Our medical practice team recovered $500,000 for a physician group when an insurer failed to properly reimburse them for their services. [read post]
20 Feb 2023, 5:00 am
CMS, the Centers for Medicare and Medicaid Services, issued a downloadable guidance on this topic. [read post]
19 Feb 2023, 7:23 pm
On January 26, 2023, the Centers for Medicare and Medicaid Services (CMS) issued guidance for Rural Emergency Hospitals (REHs), through which CMS outlined requirements on eligibility, the conversion process for eligible facilities, and other related information. [read post]
17 Feb 2023, 9:27 am
.,[2] held that the defendants were not liable under the FCA because they did not act “knowingly” since they had offered in litigation “objectively reasonable” (if not accurate) interpretations of the complex Medicare and Medicaid prescription drug pricing schemes at issue (involving accurate reporting of “Usual and Customary” pricing to ensure government payors receive the benefits of discounts provided in the market place to commercial insurers… [read post]
17 Feb 2023, 6:02 am
Centers for Medicare and Medicaid Services (CMS) announced yesterday that more than $340,000 in civil penalties have been levied against the New Jersey Veterans Memorial Home at Menlo Park after inspections last fall determined that improper care put the lives of residents in “immediate jeopardy. [read post]
17 Feb 2023, 4:13 am
Department of Health – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up) (2022-F-31) A prior audit report, issued in December 2020, identified about $50 million in actual and potential Medicaid overpayments, cost-savings opportunities, and questionable payments for services provided to recipients enrolled in Medicare-covered hospice care. [read post]
17 Feb 2023, 4:13 am
Department of Health – Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up) (2022-F-31) A prior audit report, issued in December 2020, identified about $50 million in actual and potential Medicaid overpayments, cost-savings opportunities, and questionable payments for services provided to recipients enrolled in Medicare-covered hospice care. [read post]
16 Feb 2023, 7:32 pm
As the September 1, 2023 deadline for Centers for Medicare & Medicaid Services (CMS) to publish the first 10 “selected drugs” subject to negotiation of “maximum fair prices” under Medicare Parts B and D fast approaches, CMS has recently specified information that manufacturers must submit in order for their drugs to qualify for the “Small Biotech Exception” to being included on the list. [read post]
16 Feb 2023, 9:22 am
On October 1, 2023, the Centers for Medicare and Medicaid Services (“CME”) will be retiring Section G, a measure of the functional status of nursing home residents, from the Medicare and Medicaid Minimum Data Sets (“MDS”). [read post]
15 Feb 2023, 4:25 pm
In addition to the risk of a “clawback,” or having to pay back the insurer for payments found to be in error, practitioners who fail audits face disciplinary actions from the private health insurance company, the Centers for Medicare & Medicaid Services (CMS), and the Illinois Department of Financial and Professional Regulation (IDFPR). [read post]
14 Feb 2023, 10:00 pm
The Centers for Medicaid and Medicare Services (CMS) announced a model on February 14, 2023 that would allow CMS to pay less for drugs approved via FDA’s accelerated approval pathway before a clinical benefit has been confirmed by the required confirmatory studies. [read post]
14 Feb 2023, 10:00 pm
The Centers for Medicaid and Medicare Services (CMS) announced a model on February 14, 2023 that would allow CMS to pay less for drugs approved via FDA’s accelerated approval pathway before a clinical benefit has been confirmed by the required confirmatory studies. [read post]
14 Feb 2023, 10:00 pm
The Centers for Medicaid and Medicare Services (CMS) announced a model on February 14, 2023 that would allow CMS to pay less for drugs approved via FDA’s accelerated approval pathway before a clinical benefit has been confirmed by the required confirmatory studies. [read post]
14 Feb 2023, 10:00 pm
The Centers for Medicaid and Medicare Services (CMS) announced a model on February 14, 2023 that would allow CMS to pay less for drugs approved via FDA’s accelerated approval pathway before a clinical benefit has been confirmed by the required confirmatory studies. [read post]
14 Feb 2023, 10:00 pm
The Centers for Medicaid and Medicare Services (CMS) announced a model on February 14, 2023 that would allow CMS to pay less for drugs approved via FDA’s accelerated approval pathway before a clinical benefit has been confirmed by the required confirmatory studies. [read post]
14 Feb 2023, 10:00 pm
The Centers for Medicaid and Medicare Services (CMS) announced a model on February 14, 2023 that would allow CMS to pay less for drugs approved via FDA’s accelerated approval pathway before a clinical benefit has been confirmed by the required confirmatory studies. [read post]
14 Feb 2023, 2:04 pm
On Monday, February 13, 2023, the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS), submitted a proposed rule that goes beyond current data collections requirements by requiring nursing facilities to disclose additional information regarding ownership. [read post]
