Legal and practical healthcare information.
By Marki Stewart On July 15, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed a series of rules that would create new exceptions to the Stark law, in addition to clarifying other provisions of the Stark law. One of the newly created exceptions is for “Timeshare Arrangements.” (effective January 1, 2016). This exception …
Continue reading “Analysis of New Timeshare Arrangement Exception to the Stark Law – Part 1”
By Rose Willis The 60-Day Rule was enacted as part of the Affordable Care Act on March 23, 2010 and generally requires a person who has received an overpayment to report and return the overpayment by the later of (i) the date which is 60 days after the date on which the overpayment was identified; …
Continue reading “Physician Compliance Programs: What you need to know about the Final 60-Day Rule”
By Ralph Levy The Centers for Medicare & Medicaid Services (CMS) has traditionally paid health care providers separately for each of the individual services they furnish to beneficiaries for a single illness or course of treatment. This approach to payments rewarded a quantity versus quality of care and could result in fragmented care with minimal …
Continue reading “3 Things to Consider When Dealing with Bundled Payments to Providers”
By Rose Willis The Centers for Medicare & Medicaid Services (CMS) recently released a new exception to the Physician Self-Referral Law (the “Stark Law”) intended to expand access to primary care and mental health services (the “NPP Recruitment Exception”). This exception would permit hospitals, federally qualified health centers (FQHCs) and rural health clinics (RHCs) to …
By Jessica L. Russell In 2011, CMS implemented the Accountable Care Organization (“ACO”) Shared Savings Program, which aims to promote increased savings for the Medicare program, improve health care quality, and create a more efficient and effective health care delivery system. While many deemed the ACO to be the future of health care models, the …
Continue reading “Will the ACO Proposed Rule Save the Shared Savings Program?”
By Rose Willis The United States Office of Inspector General (“OIG”) recently issued a “Special Fraud Alert” focusing on two potentially illegal trends that it has detected in arrangements between laboratories and their referring physicians: Specimen Processing Arrangements and Registry Payments. Specimen processing arrangements were the subject of an earlier blog post, “Laboratory Payments to …
Continue reading “Arrangements between Laboratories and Referring Physicians Involving “Registries””
By Jordan Schreier On July 9, 2013, the IRS issued Notice 2013-45 which provides additional information regarding the delay in the information reporting and employer shared responsibility provisions of the ACA announced earlier in July. Notice 2013-45 does not provide much in the way of substantive detail other than to confirm the delay in the …
By Scott Roberts In a recent speech to a healthcare trade group in Washington, Federal Trade Commissioner Julie Brill addressed an issue of concern to many in the healthcare industry – the apparent tension between the Affordable Care Act (“ACA”), Accountable Care Organizations (“ACOs”), and antitrust law. Addressing this perceived tension, Commissioner Brill sought to …
Continue reading “FTC Commissioner Addresses Tension Between the ACA, ACOs, and Antitrust Law”
By James M. Burns Over the last several years, several states have considered legislation that prohibits health insurers from including “most favored nation” clauses – provisions that guarantee the insurer is receiving as favorable a reimbursement rate from the provider as it offers any other insurer – in their provider contracts. The frequency with which …
By Ralph Levy, Jr. The Internal Revenue Service recently concluded that recipients of incentive payments from CMS to utilize electronic health records must include the amounts received in gross income and that CMS must report these payments to the IRS. In addition, the IRS guidance (issued in the form of a Chief Counsel Advice) gave …