Centers for Medicare & Medicaid Services (CMS) published the new hospital outpatient and ambulatory surgical center fee schedule for 2021 on August 12, 2020 at this this link: https://www.federalregister.gov/documents/2020/08/12/2020-17086/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment As part of the proposed revisions, CMS intends to transfer over 1,500 procedures from the “inpatient only” category, including 266 musculo-skeletal procedures as of 2021, the … Continue Reading
Mike Cassidy’s article, “Return to practice under the COVID threat” appears in the Bulletin of the Allegheny County Medical Society June edition.… Continue Reading
On June 23, 2020, the United States District Court for the District of Columbia denied the American Hospital Association’s (AHA) summary judgment motion claiming the Trump Administration had exceeded its authority and violated the First Amendment when it issued a new rule requiring greater price transparency. The Opinion is attached in the link below. It … Continue Reading
This is a link to the update of the OIG Work Plan that you will see it includes several new entries regarding COVID issues at nursing homes: Meeting the challenges presented by COVID Audit of nursing homes reporting of COVID-19 information Nursing home oversight during COVID-19.… Continue Reading
Yesterday (May 13, 2020), the Centers for Medicare and Medicaid Services (CMS) issued a 74-page “toolkit” to help nursing homes mitigate COVID-19 in their facilities. A copy of the CMS publication can be found here: https://www.cms.gov/files/document/covid-toolkit-states-mitigate-covid-19-nursing-homes.pdf The toolkit provides resources dedicated to addressing the very specific challenges facing nursing homes during this crisis. It is … Continue Reading
Although the Office of the Inspector General (“OIG”) has previously announced that it would exercise discretion with respect to financial arrangements entered into to facilitate and enhance the availability of COVID-19 testing, the attached Memorandum from the Office of Attorney General also indicates enhanced enforcement scrutiny with respect to fraudulent testing.… Continue Reading
The following are just some random thoughts or curated information regarding the impact the COVID pandemic will have on privacy in general, and health information privacy in particular. I have attached a link to information issued by HHS explaining that, not only are HHS and OCR specifically advising that the release of patient information regarding … Continue Reading
Attached is a PDF issued by CMS regarding blanket waivers of the Stark Law in order to allow physicians and hospitals to adjust 18 different potential financial relationships in order to deal with the COVID-19 emergency. The waivers were issued on March 30, 2020, with a retroactive effective date of March 1, 2020. They will … Continue Reading
Although many believe the HIPAA rules already allow for disclosure of COVID-19 cases on the basis of a public emergency, OCR just issued Guidance, attached in the link below, confirming disclosure is permitted when needed to provide treatment, with the notification is required by law and in order to prevent or control the spread of … Continue Reading
A vast majority of current physician employment contracts, both with larger systems and in individual practice, have some sort of productivity component for compensation, dependent upon the production of: WRVUs (Work Relative Value Unit) Collections Net Profits Even if there are no negotiated “resource” provisions, most contracts also have what was always thought to be … Continue Reading
Just a few short weeks ago, the Center for Disease Control’s Director of the National Center for Immunization and Respiratory Diseases warned that the spread of coronavirus in the U.S. was “not a question of if, but when.” As of this updated posting, the entire country is locked in an unprecedented grip of uncertainty and … Continue Reading
Just a few short weeks ago, during a press briefing by the Center for Disease Control’s Director of the National Center for Immunization and Respiratory Diseases, the director warned that the spread of coronavirus in the U.S. was “not a question of if, but when.” As of the date of this posting, there are now … Continue Reading
Click on the link to an article published in the New York Times (12/4, Abelson) reporting the American Hospital Association and other hospital groups filed a lawsuit against the Trump Administration “over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.” The hospital groups … Continue Reading
As another part of the Regulatory Sprint to Coordinated Care, OIG proposed revisions to the existing EHR Anti-Kickback Safe Harbor and added a cybersecurity component. The initial EHR Safe Harbor was developed in response to President George W. Bush’s 2004 initiative to extend EHR nationwide within 10 years, i.e. 2014. The proponents of those EHR … Continue Reading
The Pennsylvania Commonwealth Court, on remand from the Pennsylvania Supreme Court, has again decided that the previously agreed termination date of the access provisions contained in the UPMC/Highmark Consent Decrees, i.e. June 30, 2019, is not a term subject to the modification provisions of those Consent Decrees, and is definite. The adjudication of the Commonwealth … Continue Reading
This article by Mike Cassidy originally appeared in the Allegheny County Medical Society Bulletin June Edition. To read the article click here.… Continue Reading
Below is a summary of UPMC-Highmark dispute as of March 4, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012. May 1, 2012 – Parties enter into mediated agreement which states … Continue Reading
Below is a summary of UPMC-Highmark dispute as of February 22, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012. May 1, 2012 – Parties enter into mediated agreement which states … Continue Reading
Opioid Update: New Federal Law – The Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act On October 24, 2018, President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act … Continue Reading
I am inserting a link to the third in a series of articles published by the Allegheny County Medical Society regarding Medicare Payment Reform pursuant to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This article deals with Advanced Alternative Payment Models, and provides basic information on how provider groups can qualify for … Continue Reading
Click the link below to read Michael A. Cassidy’s article on Medicare Sustainable Growth which appeared on the Allegheny County Medical Society’s website on Tuesday, April 21, 2015 http://www.acms.org/ … Continue Reading
On April 14, 2013, the Pennsylvania Department of Health levied a $5.5 million surcharge for fiscal year 2013 on hospitals, ambulatory surgery centers (ASCs) and birth centers for funding the MCare professional liability debts and expenses. … Continue Reading
@medlawblog on Twitter, <http://www.twitter.com/medlawblog>, now has 302 followers and is listed on 17 lists. We tweet and retweet about the latest in health care law and news. Please check us out on Twitter.… Continue Reading
Just a few short weeks ago, the Center for Disease Control’s Director of the National Center for Immunization and Respiratory Diseases warned that the spread of coronavirus in the U.S. was “not a question of if, but when.” As of this updated posting, the entire country is locked in an unprecedented grip of uncertainty and … Continue Reading
The Pennsylvania Commonwealth Court, on remand from the Pennsylvania Supreme Court, has again decided that the previously agreed termination date of the access provisions contained in the UPMC/Highmark Consent Decrees, i.e. June 30, 2019, is not a term subject to the modification provisions of those Consent Decrees, and is definite. The adjudication of the Commonwealth … Continue Reading
