The U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) have jointly announced the launch of a reinvigorated DOJ-HHS False Claims Act Working Group aimed at enhancing interagency coordination around key fraud enforcement priorities in the healthcare space. This initiative underscores the federal government’s ongoing reliance on the False Claims … Continue Reading
The Centers for Medicare & Medicaid Services (CMS) has launched the WISeR Model (Wasteful and Inappropriate Service Reduction) to modernize and streamline Medicare’s prior authorization process. By partnering with tech companies, CMS will test the use of modern tools, such as artificial intelligence, to reduce unnecessary or low-value services that drive up costs and pose … Continue Reading
In the largest health care fraud takedown in U.S. history, the Justice Department announced charges against 324 individuals—including 96 licensed medical professionals—in connection with schemes involving over $14.6 billion in intended losses across 50 federal districts and 12 State Attorneys General Offices. The coordinated enforcement action led to the seizure of more than $245 million … Continue Reading
Attorneys Mike Cassidy and Adam Appleberry co-authored an insightful article, 2025 Medicare Final Rule Highlights, featured in the December 2024 issue of the Allegheny County Medical Society (ACMS) Bulletin. The article explores the key updates to Medicare regulations and their implications for healthcare providers. Click here to access the ACMS Bulletin to read the full … Continue Reading
Our Introduction to Telehealth, Technology and Federal Enforcement chapter was published in the Thomson Reuters 2025 Health Law Handbook. It reviewed a number of telehealth Medicare revisions, both permanent and temporary, enacted by a series of consolidated appropriation acts and physician fee schedule amendments arising out of the 2020 COVID pandemic. The temporary telehealth provisions … Continue Reading
The final Medicare Physician Fee Schedule was issued on November 1st for calendar year 2025. Attached is a link to both the Press Release describing all of the Medicare changes and the link to the entire Final Rule. The Medicare Conversion Factor for the Physician Fee Schedule was decreased from $33.29 from 2024 to $32.35 … Continue Reading
CMS proposed several telehealth changes in the 2025 Medicare Physician Fee Schedule Proposed Rule, issued July 10, 2024. Interactive Telecommunication Beginning January 1, 2025, an interactive telecommunication system may include two-way, real-time audio-only communication technology for any telehealth service furnished to a beneficiary in their home, if the distant site physician or practitioner is technically … Continue Reading
Click here for the CMS Announcement on July 10, 2024 proposing a reduction in the Medicare Conversion Factor payment from $33.29 to $32.36, i.e. 2.8% There are a host of other changes in the 24 page Release, which we will address in due course.… Continue Reading
The 2024 Consolidated Appropriations Act passed and signed on Saturday, March 23, 2024, increased of Medicare Conversion Factor from $32.7442 to $33.2875, an increase of slightly over $0.54. … Continue Reading
Penn State Health has agreed to pay $11,712,336 to settle allegations of civil liability from submitting improper claims to Medicare for Annual Wellness Visit services. DOJ Press Release Link Penn State Health has voluntarily disclosed that between December 2015 and November 2022 claims were submitted to Medicare for Annual Wellness Visit services that were not … Continue Reading
CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be reduced by 1.25% in calendar year 2024. The final PFS conversion factor will be $32.74, … Continue Reading
The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75. CMS is also proposing the following: Attached is the Fact Sheet released by CMS on July 13, 2023.… Continue Reading
The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. As previously reported, the changes to the Medicare Physician Schedule Conversion Factor would have reduced physician reimbursement by 4.5%. … Continue Reading
On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor. The general Medicare conversion factor will be reduced by 4.4% from $34,61 to $33.08 The anesthesia conversion factor will be reduced 3.9% from $21.56 to $20.72 The link is attached … Continue Reading
There has been much discussion and controversy over the new CMS position on billing for split/shared services in facility settings. As originally proposed, and starting in January 2022, if the service was shared among providers (such as physicians and physician assistants), the provider who performed the substantive portion of the visit would be the provider … Continue Reading
Under the Federal Ethics in Patient Referrals Act (more commonly known as “Stark”), if a physician[1] has a financial relationship with an entity, the physician may not refer patients to the entity for medical services payable by Medicare unless the financial relationship complies with the Stark safe harbors. Thus, entities that lease or sublease space or … Continue Reading
In MLN Matters article MM 12159, CMS has published summaries of the following: Updates to payment policies and Medicare payment rates for services provided by physicians and non-physician practitioners (NPP) Updates to Medicare telehealth services and telehealth originating site facility fee payment amounts Billing for a physician assistant (PA) services … Continue Reading
MLN Connects, on Monday August 16, 2021, published a special edition on COVID-19 vaccines codes and payment. It references the CMS explanation entitled “Medicare COVID-19 Vaccine Shot Payment”. I have also attached a PDF of both documents if you cannot access the links.… Continue Reading
The 2022 Medicare Physician Fee Schedule was proposed and published by CMS on Friday, July 23, 2021. Here is the link: https://www.govinfo.gov/content/pkg/FR-2021-07-23/pdf/2021-14973.pdf… Continue Reading
Click here to read the article on the 2021 Medicare Physician Fee changes which appeared in the March 2021 edition of the Allegheny County Medical Society Bulletin. … Continue Reading
CY 2021 Physician Fee Schedule Update On December 27, 2020, the Consolidated Appropriations Act modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a 3.75% increase in MPFS payments for CY 2021 Suspended the 2% payment adjustment (sequestration) through March 31, 2021 Reinstated the 1.0 floor on the work Geographic Practice Cost … Continue Reading
This article written by Michael A. Cassidy and Jerry J. Russo appeared in the October 2020 Issue of the Allegheny County Medical Society Bulletin.… Continue Reading
