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CMS 2021 Fee Schedule Expands ASC Procedures

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

Federal Court Rejects American Hospital Association Challenge to Trump Price Transparency Rule

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

CMS Issues Toolkit to Aid Nursing Homes in Fighting COVID-19

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

Priority COVID-19 Fraud Enforcement

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

COVID Impact: HIPAA and Privacy

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

COVID-19 and Physician WRVU Productivity

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

Workers’ Compensation Claims for Healthcare Professionals Exposed to COVID-19 in PA – Updated March 17, 2020

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

Hospital Groups File Lawsuit Challenging Rule That Would Require Them To Disclose Prices Given To Insurers

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

Anti-Kickback EHR and Cybersecurity Safe Harbor

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

Pennsylvania Commonwealth Court Again Declines to Extend Consent Decree

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

Opioid Update: New Federal Law

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

Macranomics III: APMS

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
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