Tag Archives: hospitals

CMS Digging In on Medicaid DSH Payments

By Susan Feigin Harris and Geri Edens on Posted in Uncategorized
During the summer months, several developments have occurred concerning the Medicaid Disproportionate Share Hospital (DSH) policy that the Centers for Medicare & Medicaid Services (CMS) has implemented, to the detriment of a number of hospitals. These hospitals and state hospitals associations have challenged CMS in district courts all over the country and several courts ruled … Continue Reading

IPPS Proposed Rule Increases Hospital Payment; Solicits Ideas for Achieving Transparency, Relieving Administrative Burden

Photo of Amy FoutsPhoto of Ernessa McKiePhoto of Katy ApplebyBy Amy Fouts, Ernessa McKie and Katy Appleby on Posted in Uncategorized
The Centers for Medicare & Medicaid Services (CMS) recently issued its proposed rule updating fiscal year (FY) 2018 payment policies and rates under the Medicare inpatient prospective payment system (IPPS). As highlighted below, the proposed rule aims to reduce regulatory burdens for providers and to promote transparency and flexibility in the delivery of care. Comments … Continue Reading

Resistance Is Futile: CMS Gets Serious About Antibiotic-Resistant Bacteria

Photo of Kyle GregoryPhoto of Emily CrosbyBy Kyle Gregory, Greg Fosheim and Emily Crosby on Posted in Uncategorized
Antibiotics and similar drugs, known more broadly as antimicrobial agents, are an instrumental weapon in the healthcare armory, rendering once-lethal infections treatable, and dramatically reducing instances of sepsis and secondary infections associated with cancer chemotherapy and organ transplants. However, sub-therapeutic use of antimicrobial agents in livestock, over-prescription, bacterial evolution and myriad other factors have contributed … Continue Reading

Texas Judge Halts December 1 Implementation of Department of Labor’s “Overtime Final Rule”

Photo of Ashlee GrantBy Ashlee Grant on Posted in Uncategorized
Christmas came early for many employers yesterday when, in a stunning turn of events, Judge Amos L. Mazzant III of the Eastern District of Texas issued a nationwide injunction halting the implementation of the Department of Labor’s Overtime Final Rule. This Overtime Final Rule would have doubled the requisite minimum salary threshold for employees to … Continue Reading

The Proposed Medicaid DSH Rule: Hospitals, States and Associations Declare It Legally Insufficient

By Susan Feigin Harris on Posted in Uncategorized
The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule addressing the treatment of third-party payments when calculating uncompensated care costs for the Medicaid disproportionate share hospital (DSH) formula (Proposed Rule). While CMS maintains the Proposed Rule merely clarifies longstanding policy, industry stakeholders submitting comments prior to the September 14 deadline disagree, … Continue Reading

CMS Announces Final Rule Updating Fire Safety for Healthcare Facilities

Photo of Joel D. GottesmanBy Joel D. Gottesman on Posted in Uncategorized
The Centers for Medicare and Medicaid Services (CMS) recently published a final rule updating fire safety requirements for healthcare facilities in an effort to increase patient safety and adapt to the needs of an aging population. The new rule adopts provisions of the National Fire Protection Association’s (NFPA) 2012 edition of the Life Safety Code (LSC), as … Continue Reading

FY 2017 IPPS Proposed Rule Results in Modest Increase for Hospitals

Photo of Amy FoutsPhoto of Ernessa McKiePhoto of Kyle GregoryBy Amy Fouts, Ernessa McKie and Kyle Gregory on Posted in Uncategorized
CMS recently issued a proposed rule updating fiscal year (FY) 2017 Medicare payment policies and rates under the Medicare inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment system. Highlights of the proposed rule applicable to IPPS hospitals are the focus of this summary. With the proposed rule, CMS continues to emphasize its … Continue Reading

News Flash: An Agreement Between Competitors to Limit Advertising/Marketing Violates the Antitrust Laws

By Jonathan Lewis on Posted in Uncategorized
For the second time in less than a year, the U.S. Department of Justice (DOJ) has filed an antitrust complaint against hospital systems that agreed to not advertise on billboards or in print in each other’s home county. Last time it was a number of hospital systems in Michigan. This time, it is two hospital systems … Continue Reading

Texas Open Carry Law: FAQs for Hospitals and Healthcare Facilities

Photo of Gregory S. SaikinBy Michael Lombardino and Gregory S. Saikin on Posted in Uncategorized
As of January 1, 2016, concealed license holders in Texas can now legally carry their handguns visibly in hip or shoulder holsters. This comes at a time when violence in hospitals and healthcare facilities is on the rise. According to a 2015 survey published by the International Association for Healthcare Security and Safety Foundation, from … Continue Reading

Don’t Get Phished! Hackers Pose as CEOs to Steal Tax Information from HR and Payroll Professionals at Healthcare Organizations

Photo of Melinda L. McLellanPhoto of Lynn SessionsBy Melinda L. McLellan and Lynn Sessions on Posted in Uncategorized
Every tax season is plagued with scams to defraud individuals and companies for money from tax returns. However, this year has started off with a bang and this means that the healthcare industry has another reason to worry. On March 1, 2016, the IRS issued an alert warning “payroll and human resources professionals to beware of an … Continue Reading

Protecting Patient Data From Hacker Ransom Demands

By Suchismita Pahi on Posted in Uncategorized
Forty bitcoins later (approximately $17,000), Hollywood Presbyterian Hospital can now access its electronic medical health records and return to treating its patients as scheduled. But as hackers develop new tools to access information, an increasing number of providers will be targeted and ransom demands will escalate, putting hospitals and patients at risk. Focusing on technical … Continue Reading

Providers Oppose CMS Proposal Targeting Prescription Drug Abuse by Part D Enrollees

By Kameron Brackins on Posted in Uncategorized
Providers have voiced opposition to a proposal aimed at targeting Medicare Part D enrollees with “potential opioid or acetaminophen overutilization issues that indicate the need to implement appropriate controls on these drugs for the identified beneficiaries.” Under a recently proposed rule on revised discharge planning requirements, CMS solicited comments on whether providers should be required to consult … Continue Reading

Meaningful Use Stage 3 Final Rule Reduces Provider Burdens

Photo of Lynn SessionsBy Lynn Sessions and Suchismita Pahi on Posted in Uncategorized
CMS and the Office of the National Coordinator for Health Information (ONC) recently released the 752-page final rule for Meaningful Use Stages 2 (MU2) and 3 (MU3). The final rule provides a flexible timeline for providers and reduces the number of objectives and accompanying clinical quality measures required for reporting. The rule further provides that: … Continue Reading

D.C. District Court Deals Blow to HHS 340B Program Interpretive Rule

Photo of Lee H. RosebushPhoto of Lindsay HolmesBy Lee H. Rosebush and Lindsay Holmes on Posted in Uncategorized
Court says Congress has the power to make the change that HHS attempted with its Interpretive Rule, and thus it should be left to the legislative branch. A lawsuit challenging the Interpretive Rule, filed by the Pharmaceutical Research and Manufacturers of America (PhRMA) in October 2014, was recently vacated in favor of PhRMA by the … Continue Reading

340B Guidance: Eight Key Points Covered Entities Should Consider

Photo of Lee H. RosebushPhoto of Lindsay HolmesBy Lee H. Rosebush, Dena Kessler, Nita Garg and Lindsay Holmes on Posted in Uncategorized
On August 27, 2015, the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), released the 340B Drug Pricing Program Omnibus Guidance (Guidance). Referred to as “proposed” guidance by HRSA, the Guidance is intended to clarify a multitude of issues for the thousands of registered covered … Continue Reading

CMS Releases CY 2016 OPPS Proposed Rule With Updates to Two-Midnight Rule and Other IPPS Proposals

Photo of Kathy Butler PolvinoPhoto of Jennifer WhittonBy Kathy Butler Polvino and Jennifer Whitton on Posted in Uncategorized
On July 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2016 outpatient prospective payment system (OPPS)/ambulatory surgical center (ASC) payment system proposed rule that updates payment policies and rates for hospital outpatient departments and ASCs. The proposed rule also includes certain proposals relating to the hospital inpatient prospective … Continue Reading

Proposed 340B Rule Would Impose Penalties for Overcharging, Plus Other Charges

Photo of Lee H. RosebushBy Lee H. Rosebush and Dena Kessler on Posted in Uncategorized
A recently-released proposed rule would impose civil monetary penalties on drug manufacturers that intentionally overcharge healthcare providers for medications purchased under the 340B Discount Drug Program. The proposed rule, if adopted, could open the door to significant financial penalties for manufacturers, even if it is the manufacturer’s wholesaler or other business partner that overcharges the … Continue Reading

New Limitations on RAC Program

By B. Scott McBride and Nita Garg on Posted in Uncategorized
In March 2014, CMS temporarily suspended the Recovery Audit Contractor (RAC) program until it secured new contracts. The contracts for the program expired in June 2014, and in August, CMS said that it would restart the program on a restricted basis under a new contract that allows recovery auditors to review a limited number of … Continue Reading

CMS Releases New Proposal to Improve Accountable Care Organizations

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule aimed at revitalizing accountable care organizations (ACOs) under the Medicare Shared Savings Program (MSSP). Given the low level of ACOs receiving shared savings payments in their first year, CMS is making several proposals to adjust participants’ risk levels to encourage continued participation. … Continue Reading

2015 Medicare OPPS and ASC Final Rule

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
On November 10, 2014, the Centers for Medicare and Medicaid Services (CMS) published the Outpatient Prospective Payment System (OPPS) final rule for 2015. The rule updates CMS’s payment rates and policies, value-based purchasing measures and quality measures for services furnished in hospital outpatient departments and ambulatory surgical centers (ASCs) effective as of January 1, 2015. … Continue Reading

Ebola Matters of First Impression; Law Lags Behind Policy

By Susan Feigin Harris on Posted in Uncategorized
While we turn to science and laws to guide our response to matters in the healthcare industry, the entrance of the Ebola virus into our lives here in the U.S. has challenged our abilities, both from a medical and legal perspective. We know what to do, but our abilities to respond adequately, timely and responsibly … Continue Reading

Another Federal Court Decertifies FLSA Collective Action of Hospital Workers Challenging Auto-Deduct Policy

Photo of Gilbert BroskyBy Gilbert Brosky on Posted in Uncategorized
Courts continue to recognize that the use of an automatic meal deduction policy, without more, is not enough for plaintiffs to prevail on a FLSA collective action. In this instance, the plaintiffs were current and former healthcare employees of St. Mary Medical Center who were subject to an automatic 30 minute meal period deduction which, … Continue Reading

Lee Simowitz Discusses Antitrust in the Healthcare Industry

Photo of BakerHostetlerBy BakerHostetler on Posted in Uncategorized
BakerHostetler partner Lee Simowitz spoke as part of the panel, “Negotiating the antitrust minefield,” during Modern Healthcare’s Virtual Conference and Expo, “Building Tomorrow’s Delivery Model: Forging a Path to Value,” on October 15. The Affordable Care Act is driving ever-increasing rates of consolidation in the healthcare industry. But even as hospitals and health systems explore … Continue Reading
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