Swing vote by Chief Justice John Roberts reflects his support of judicial precedent. On June 26 the U.S. Supreme Court issued a decision (https://www.supremecourt.gov/opinions/18pdf/18-15_9p6b.pdf)  on how courts should handle ambiguous government regulations.  Many people, including me, expected that the case would change the level of deference courts grant to a…
OMHA’s new eligibility requirements are intended to benefit more providers. The Office of Medicare Hearings and Appeals (OMHA) has expanded its Settlement Conference Facilitation (SCF) program, and it is now open to the appellant community. By way of background, Settlement Conference Facilitation (SCF) is an alternative dispute resolution process designed…
This case of goes beyond DSH payments. Earlier this month the U.S. Supreme Court decided an appeal brought by Allina and many other hospitals challenging the methodology the government used when calculating disproportionate share payments. But even if this sounds irrelevant, don’t stop reading, because this decision will have an…
Trump’s Executive Order will include a requirement to disclose contracted rates. U.S. Health and Human Services (HHS) Secretary Azar and White House officials held a meeting this morning to explain an executive order that the President plans on releasing today on healthcare price transparency.   Officials said that the executive…
Recent report from HHH/OIG faults CMS. A recent study by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) revealed a concerning series of findings related to the under-reporting of instances of potential abuse and/or neglect of elderly Medicare patients. Every year, tens of thousands…
CMS agrees to settle appeals for IRF facilities following a two-year disputed with the industry. The Centers for Medicare & Medicaid Services (CMS) has announced voluntary settlement options for inpatient rehabilitation facility (IRF) providers with claims that have not yet exhausted the Qualified Independent Contractor (QIC), Office of Medicare Hearings…
Ensuring your documentation meets medical necessity standards In 2003, the Centers for Medicare & Medicaid Services (CMS) made a change within the Claims Processing Manual regarding the selection of the evaluation and management (E&M) level of service to be effective in 2004. This change made the need, reason, or extensiveness…
Payers and providers square off to ensure patients aren’t stuck with huge costs. EDITOR’S NOTE: Matthew Albright, chief legislative affairs officer for Zelis and the former Director of the Administrative Simplification Group of the Centers for Medicare & Medicaid Services (CMS), granted me an interview recently. What follows are excerpts…
Major realignment is scheduled for this weekend. As reported last week by RACmonitor, in a restructuring of the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) jurisdictions, the Centers for Medicare & Medicaid Services (CMS) created 10 regions across the United States and awarded KEPRO, a BFCC-QIO, a new five-year…
CORRECTION: Because of a publishing error, this article, written by healthcare attorney David Glaser, was published on May 30 by RACmonitor after the new guidance was actually published. That guidance can be found here, https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO-19-13-Hospital.pdfIn a statement to RACmonitor, Glaser offered comments about the new guidance from the Centers for…