On April 14, 2020, CMS released a ruling that will increase the reimbursement for tests conducted to detect SARS–CoV–2 (the diagnosis of the virus that causes COVID–19) for tests utilizing “high throughput technologies.” The reimbursement under Medicare Part B for these laboratory tests will be raised from about $51 per test to $100 per test. This increase will begin with tests performed on or after March 18, 2020 and end when the national emergency is over.
Treating COVID-19 Patients: Evaluating College Dorms, Professional Arenas, Fitness Centers and Convention Centers
As many of you are aware, the Centers for Medicare and Medicaid Services (CMS) along with many states have waived licensing and other requirements to allow healthcare providers to use non-hospital space to treat COVID-19 and non-COVID-19 patients, conduct testing and perform other clinical operations. Healthcare providers across the country are exploring options to increase
COVID-19 Hospice How-To Series: Taking Advantage of the Temporary Quality Reporting Data Submission Relief
On March 22, 2020, and as subsequently clarified on March 27, 2020, the Centers for Medicare and Medicaid Services (“CMS”) temporarily lifted the requirements for hospices to submit Hospice Item Set (“HIS”) data and hospice Consumer Assessment of Healthcare Providers and Systems (“CAHPS”) survey data. Prior to CMS’s action, failure to comply with these data reporting requirements of the Hospice Quality Reporting Program (“HQRP”), absent an exception, resulted in a 2 percent reduction to a hospice’s annual Medicare payment update.
COVID-19: CMS Waiver Information for LTCHs and IRFs
On Friday, March 13, 2020, CMS issued blanket waivers under 42 U.S.C. 1320b-5 that impact long term acute care hospitals (LTCHs) and inpatient rehabilitation facilities (IRFs) as a result of President Trump declaring a state of an emergency due to COVID-19. The blanket waivers temporarily allow facilities operating inpatient rehabilitation units to exclude patients admitted
New CMS Disclosure Rule Implemented
The Centers for Medicare and Medicaid Services (CMS) recently issued a final rule that includes several anti-fraud measures and significantly enhances the agency’s authority to exclude new and current providers and suppliers that are identified as posing an undue risk of fraud, waste or abuse. The new measures require providers and suppliers to disclose to CMS upon its request and upon application for initial enrollment or revalidation any “affiliations” or parties who have one or more defined “disclosable events.” The rule went into effect November 4, 2019.
The new rule requires all providers to disclose any current or prior affiliations within the past five years that the provider—or any of its owning or managing employees or organizations—has or had with a current or former Medicare provider with a “disclosable event,” which is triggered by any of the following:
- an uncollected debt to CMS
- current or previous payments suspension from a federal health care program
- current or previously exclusion from healthcare programs
- previous denial, revocation or termination of Medicare, Medicaid or CHIP billing privileges
Price Transparency in Health Care . . . Panacea or Not
Time is running short on the opportunity to comment on a proposed rule further increasing transparency in hospital pricing. The rule was released July 29 and was quickly panned by providers and insurers over provisions requiring hospitals to publicly disclose the negotiated rates they have with third-party payers.
Comments on the rule are due September 27, 2019.
Action by the federal government to increase price transparency in health care is not new, of course. Section 2718(e) of the Public Health Service Act (PHS) was added by the Affordable Care Act to require all hospitals to make public, upon request, the standard charges for the items and services they provide.
CMS Finalizes Helpful Change to Stark Law Signature Exception
In January of 2019, the Centers for Medicare and Medicaid Services (“CMS”) implemented a helpful change to the signature exception to the Stark Law. In particular, the exception may now be used more than once during a 3-year period for compensation arrangements with the same referring physician.
History of Signature Exception
The signature exception to the Stark Law has undergone several revisions within the past few years. The original version of the exception was implemented by CMS effective October 1, 2008 in response to concerns regarding the potential for significant Stark Law penalties for mere “technical” violations of the statute. The original language in the signature exception provided for a grace period for noncompliance with the signature requirement of many of the compensation arrangement exceptions to the Stark Law, such as the personal service arrangements exception and fair market value exception. In particular, a 90-day grace period was permitted for late signatures that were inadvertent, and a 30-day grace period was permitted for late signatures that were “not inadvertent.” In addition, the exception could only be used once for the same referring physician during a 3-year period. In other words, after the exception was used once by a DHS entity for a late signature on a compensation agreement with a referring physician, any late signatures on other agreements entered into by the DHS entity and the same referring physician during the following 3-year period would trigger a violation of the Stark Law.
Physician Quality Measures—Growing Numbers of them, but are they being used?
For decades, pundits, policymakers and consumer groups have called for better tools to make health care purchasing decisions easier. Greater cost transparency and clear indicators of quality, they say, would help consumers make the right choices, which would lead to lower costs and better quality care.
If only it were as easy as using Angie’s List: describe the need and up pops the names of local providers, along with comparative information on their performance.
Increasingly, such information and tools are available. But their impact is unclear.
Since 2010, Medicare consumers have had an “Angie’s List” type of resource in Physician Compare, an online service produced by the Centers for Medicare and Medicaid Services (CMS). The website was mandated by the Patient Protection and Affordable Care Act (ACA). It serves a two-fold purpose, according to CMS:
Hospitals React Strongly to CMS’ Changes to Hospital Outpatient Payments
Hospitals are not happy with CMS’ recent changes to hospital outpatient payments. Two hospital associations and three hospitals claim in a federal lawsuit filed December 4, 2018, that CMS had no authority to change the payment scheme for off-campus provider-based departments (PBDs). The change took effect January 1, 2019, and is estimated to reduce payments to hospitals by $380 million in the first year of a two-year phase-in period.
The plaintiffs, including the American Hospital Association and the Association of American Medical Colleges, are seeking judgment that the payment change is unenforceable as well as preliminary and permanent injunctive relief. The complaint against US Department of Health and Human Services Secretary Alex Azar was filed in the U.S. District Court for the District of Columbia.
The plaintiffs’ assert that the reduced payments threaten patient access to care and harm the providers’ ability to meet the health care needs of their patients, including some of the most vulnerable populations.
CMS Issues Proposed Rule Addressing Payment Error in Medicare Advantage, Expects to Recover $4.5 Billion Over 10 Years
A new rule proposed by the Centers for Medicare and Medicaid Services (CMS) on October 26, 2018, would revise the way the agency validates the risk adjustment data and collects repayments from Medicare Advantage (MA) organizations. With the new methodology, CMS is expecting to return $4.5 billion in savings to the Medicare Trust Fund over 10 years, according to an October 26 CMS news release.