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Catherine A. Hurley

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Last week, the OIG released two new studies analyzing what and how Medicare pays for clinical laboratory tests (“lab tests”).

The first study, Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015: Year 2 of Baseline Data, analyzed Medicare Part B claims data for lab tests performed in 2015 and reimbursed under the Clinical Laboratory Fee Schedule.  OIG compared this data with the same claims data for 2014, and found that, among other things:
Continue Reading New OIG Studies Reveal Clinical Lab Test Payment Trends and CMS’ Progress in Implementing PAMA

In order to assist the clinical laboratory community in meeting new Medicare reporting requirements under the Protecting Access to Medicare Act of 2014 (PAMA), CMS has posted a Clinical Laboratory Fee Schedule Data Reporting Template and a “Quick User Guide” to the template.  By way of background, PAMA requires CMS to base Medicare…

Today the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would modify the discharge planning conditions of participation (COPs) for hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies (HHAs). The proposed rule would implement the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).  The proposed changes are designed to promote “consumer-centered health care” by requiring the affected provider types to, among other things, solicit patient input with respect to discharge planning, and to share information among relevant parties, including the patents/caregivers, the physician, and the post-acute provider to whom the patient is discharged if applicable.
Continue Reading CMS Publishes Proposed Rule on Hospital/HHA Discharge Planning Requirements

Today President Obama signed into law H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.
Continue Reading President Obama Signs MACRA: Permanently Reforms Medicare Physician Reimbursement Framework, Includes Other Health Policy Provisions

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that implements Medicare Secondary Payer (MSP) appeals provisions under the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act). Specifically, the rule addresses the right of appeal and a new multilevel appeal process for liability insurance (including self-insurance), no-fault insurance, and…

On April 1, 2014, President Obama signed into law H.R. 4302, the “Protecting Access to Medicare Act of 2014” (“the Act”). The Act includes a one-year Medicare physician fee schedule fix that averts a nearly 24 percent payment cut set for April 1, 2014, but which falls far short of earlier hopes for full repeal of the current sustainable growth rate (SGR) formula. The Act also includes numerous other Medicare payment and policy changes, including skilled nursing facility value-based purchasing provisions, reforms to the physician fee schedule relative valuation process, a new framework for clinical laboratory payments, a variety of changes impacting imaging services, changes in the exceptions for long term care hospitals, and extension of certain expiring provisions. In other areas, the bill includes a one-year delay in the transition to ICD-10, changes to the timetable for Medicaid disproportionate share hospital cuts, and “front-loading” of the 2024 Medicare sequestration reduction.
Continue Reading President Signs Medicare Physician Fee Schedule/SGR Patch with Numerous Health Policy Provisions

CMS has published an advance notice of proposed rulemaking soliciting comments on the imposition of civil money penalties (CMPs) for failure to comply with Medicare Secondary Payer (MSP) reporting requirements for certain group health and non-group health plans arrangements. Importantly, the SMART Act revised the language addressing CMPs of $1000 per day for responsible reporting…

Reed Smith attorneys have prepared a Client Alert which provides a summary of the most significant proposed changes to the Medicare program’s long-term acute care hospital prospective payment system (“LTCH-PPS”) for fiscal year (“FY”) 2012. On Tuesday, April 19, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released on its website an advance copy of the “Proposed Rule” revising the LTCH-PPS for fiscal year FY 2012, which applies to discharges occurring on or after October 1, 2011 through September 30, 2012. The official copy of the Proposed Rule will be published in the Federal Register in the coming days. Comments on the Proposed Rule must be submitted no later than 5 p.m. on June 20, 2011.
Continue Reading CMS Issues Proposed Changes to LTCH Payment Rates and Other Payment Policies for Fiscal Year 2012

This post was also written by Areta Kupchyk.

The FDA has published a final rule reclassifying Medical Device Data Systems (MDDS) as Class I medical devices exempt from 510(k) premarket notification requirements. FDA defines MDDS as medical devices that are intended to transfer, store, convert from one format to another according to preset specifications,…