Following up on the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Department of Health and Human Services (HHS) recently issued a proposed rule to replace the Medicare sustainable growth rate (SGR) methodology which was repealed by MACRA. The proposed rule would implement the Merit-based Incentive Payment System (MIPS) to replace SGR and establish incentives for participation in Advanced Alternative Payment Models (Advanced APMs) ...
A number of events have occurred recently involving the Federal Trade Commission and healthcare entities. First, garnering the lead spotlight, the FTC began presenting its case in the U.S. District Court for Northern Illinois to enjoin a merger between Advocate Health and NorthShore University HealthSystem, two large Chicago-area health systems ...
Most people probably associate cyber-crime with issues of national security—what with Russia dominating so much space in the headlines, lately. However, cybersecurity breaches can have a palpable and damaging effect on everyday individuals, due to how often they’re tied to corporate security breaches involving highly sensitive personal information like credit card numbers, social security numbers, and contact information ...
In August 2016, the Office of the National Coordinator for Health Information Technology (ONC) and the National Institute of Standards and Technology (NIST) co-sponsored the Use of Blockchain in Health IT and Health-related Research Ideation Challenge, soliciting whitepapers on how blockchain technology can be used in health care ...
The second HIPAA settlement of 2021 is the first traditional enforcement action of the year. And, it’s a big one. Traditionally, OCR enforcement has been triggered by breaches. In 2020, however, we saw a significant increase in a sub-set of Privacy Rule enforcement arising out of the U.S. Department of Health and Human Services’ Office for Civil Rights’ (OCR) patient “Right of Access” initiative ...
On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule intended to prohibit hospitals operating certain off-campus provider-based departments (PBDs) from billing under the Outpatient Prospective Payment System (OPPS). In an effort to implement Section 603 of the Bipartisan Budget Act of 2015, CMS says the proposed rule will save about $500 million a year by refocusing payments on the patient rather than the clinical setting ...
The financial exploitation of elders is a hot topic in state legislatures, with the federal government, and in the media. In the first few months of 2017 alone, media reports from Gadsden, Fairhope and Dothan chronicle four cases of financial exploitation, with losses in each case ranging from $20,000 to $100,000 over short periods of time. The perpetrator in each case was a family member of the victim ...
Many governmental authorities across the country have ordered “nonessential” businesses to shut down because of the COVID-19 crisis. Many business owners are asking what that means for the business income losses that they are forced to endure and whether insurance will cover those losses. Most property insurance policies that offer business interruption coverage provide some form of “civil authority” coverage ...
Two schools of thought have emerged on business interruption insurance coverage for coronavirus, either (a) it is a total panacea that will shift the risk of coronavirus revenue losses to insurance carriers or (b) there is no possible coverage for losses caused by coronavirus. As with most things in life and insurance, the truth lies somewhere in between and will depend on the specific policy at issue and the jurisdiction interpreting the policy ...
Last month, CMS issued a proposed rule that would drastically expand the agency’s authority to further its program integrity efforts through the provider and supplier enrollment process. This proposed rule, referred to as CMS-6058-P, (located in the Federal Register at 81 Fed. Reg. 40 ...
Gov. Jerry Brown signed California Senate Bill 826 into law, which requires publicly held companies whose principal executive offices are located in California to have a minimum of one woman on their boards of directors by the end of 2019. Thereafter, women’s representation will have to increase based on the law, with what will be codified as Section 301 ...
Tilray, Inc. officially launched its initial public offering on Thursday, becoming the first U.S. cannabis cultivator to directly list on an American exchange. Based on a better-than-expected share price of $17, the company raised more than $153 million in the offering. The IPO is notable for two reasons: 1) Tilray was incorporated in Delaware in January 2018 and is, therefore, the first U.S. cannabis company allowed to list directly on Nasdaq. The company’s U.S ...
Last month, Waller published an article (Bank Interagency group offers guidance on working with borrowers affected by COVID-19) analyzing guidance issued by the federal financial regulatory agencies encouraging lenders to “work constructively with borrowers” and offer loan modification programs in a safe and sound manner to mitigate the adverse effects of COVID-19 ...
CHALLENGE Promise Healthcare Group, LLC was one of the nation’s largest healthcare providers focused on post-acute care services. The investor-owned company operated two freestanding medical-surgical hospitals, 14 long-term acute care hospitals (LTACHs), and two skilled nursing facilities. The company also had 45 affiliates across eight states ...
Earlier this year, the Congressional Budget Office (CBO) released its report on the direct spending and revenue effect of H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the House of Representatives. CBO made this estimate in conjunction with the Joint Committee on Taxation ...
The Commodity Futures Trading Commission (CFTC) has clarified the priorities and expectations when a designated contract market (DCM) or swap execution facility (SEF) lists new virtual currency derivatives or when a derivatives clearing organization (DCO) clears virtual currency derivatives. Background and Key Terms The CFTC is an independent federal agency that administers the Commodity Exchange Act, which regulates transactions in commodity interests ...
The focus on the response to the Coronavirus (COVID-19) has primarily centered around prevention and containment but the government and commercial payors have also addressed healthcare operational matters that encourage prompt diagnosis, treatment and monitoring through billing and reimbursement modifications and expansion of telehealth services ...
A new reimbursement model intended to address healthcare access and availability in rural communities was introduced by The Centers for Medicare & Medicaid Services (CMS) Innovation Center. The Community Health Access and Rural Transformation (CHART) Model will “provide up-front investments and predictable, capitated payments that pay for quality and patient outcomes,” according to CMS ...
On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) announced updates to its survey process in response to COVID-19 (press release,press release, andmemo). Specifically, as authorized pursuant to section 1135(b)(5) of the Social Security Act, CMS is prioritizing certain surveys and exercising enforcement discretion for all certified provider and supplier types for the next three weeks ...
On April 6, 2020, the Centers for Medicare and Medicaid Services (CMS) published an interim final rule in the Federal Register that, among other initiatives and changes to existing policy, allows certain inpatient hospital services to be provided “under arrangements” outside of the hospital. The “March 2020 IFC” is intended to give healthcare providers increased flexibility to respond to the public health emergency created by COVID-19 ...
On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) released an FAQ on Medicare provider enrollment relief, noting several key changes aimed at streamlining and expediting provider enrollment in light of COVID-19. Physicians and non-physician practitioners may now enroll and receive temporary billing privileges without certain fingerprint-based criminal background checks and site visits ...
The Centers for Medicare & Medicaid Services hasrecently announced an unprecedented “Hospitals Without Walls” program to aid in the fight against COVID-19. The goal of this program is to ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites including other, non-affiliated healthcare providers and even unlicensed locations such as community centers and schools ...
