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The Supreme Court’s Rulings on COVID-19 Vaccine - Bill of Health

(Just Now) WEBThe Supreme Court’s decision puts those injunctions on hold, allowing CMS’s vaccination requirements for health care workers to take effect while the cases …

https://blog.petrieflom.law.harvard.edu/2022/01/18/supreme-court-vaccine-mandate-osha-cms/

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Twenty-Three Individuals Charged in $61.5 Million Medicare Fraud …

(8 days ago) WEBMary Smelter-Bolton, 69, of Oakland County, and Cass Hawkins, 52, of Wayne County, were allegedly recruiters paid by various Jamil home health agencies to …

https://www.justice.gov/opa/pr/twenty-three-individuals-charged-615-million-medicare-fraud-schemes

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Blog: Updates on Legal Challenges to CMS and OSHA Vaccine …

(5 days ago) WEBJanuary 7, 2022 at 10:00 a.m. ET. Key Insights from the Oral Arguments Before the Supreme Court in Vaccine Mandate Cases. The U.S. Supreme Court …

https://www.aha.org/news/blog/2021-12-01-blog-updates-legal-challenges-cms-vaccine-mandate-rule

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Major Questions about Vaccine Mandates, the Supreme - Bill of …

(8 days ago) WEBBy Wendy Parmet and Dorit Reiss. This Friday, the Supreme Court will hear arguments about two federal vaccine mandates: the Centers for Medicare and …

https://blog.petrieflom.law.harvard.edu/2022/01/05/major-questions-vaccine-mandates-supreme-court/

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Most nursing homes don't have enough staff to meet the federal …

(4 days ago) WEBA CMS-commissioned study in 2001 found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth …

https://www.npr.org/sections/health-shots/2024/04/24/1246628171/nursing-home-staffing-final-rule-medicare-medicaid

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Health-Related Litigation And The Supreme Court: The …

(8 days ago) WEBThis article discusses the holdings and implications of Supreme Court decisions through June 21, 2022 focusing on Medicare payment cuts to 340B hospitals, employers’ coverage of dialysis

https://www.healthaffairs.org/content/forefront/health-related-litigation-and-supreme-court-2021-term-part-1

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Supreme Court's False Claims case alleges overbilling of Medicare …

(2 days ago) WEBThe Supreme Court on Tuesday hears a case that considers whether pharmacies knowingly overcharged Medicare and Medicaid under the False Claims …

https://www.npr.org/2023/04/17/1169367263/supreme-court-looks-at-whether-medicare-and-medicaid-were-overbilled-under-fraud

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FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and …

(1 days ago) WEBHealth Equity Impacts. The rule also advances one of the goals of the CMS Framework for Health Equity 2022-2032 – to more explicitly measure the impact of our …

https://www.cms.gov/newsroom/fact-sheets/fy-2024-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0

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Biden-Harris Administration Takes Historic Action to Increase …

(5 days ago) WEBThe U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today issued three final rules to fulfill …

https://www.hhs.gov/about/news/2024/04/22/biden-harris-administration-takes-historic-action-increase-access-quality-care-support-families-care-workers.html

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CMS Finalizes Physician Payment Rule that Advances Health Equity

(6 days ago) WEBContact: HHS Press Office 202-690-6343 [email protected]. CMS Finalizes Physician Payment Rule that Advances Health Equity. Final policies will expand …

https://www.hhs.gov/about/news/2023/11/02/cms-finalizes-physician-payment-rule-advances-health-equity.html

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Laws Against Health Care Fraud Fact Sheet - Centers for …

(5 days ago) WEBThe Health Care Fraud Statute makes it a criminal offense to knowingly and willfully execute a scheme to defraud a health care benefit program. Health care fraud is …

https://www.cms.gov/files/document/overviewfwalawsagainstfactsheet072616pdf

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Federal Guidance on Balance Billing: The No Surprises Act and its

(7 days ago) WEBIn cases where the Member cannot travel, or where there are no in-network facilities or providers located within a reasonable travel distance, the balance billing …

https://www.healthcarelawinsights.com/2021/07/federal-guidance-on-balance-billing-the-no-surprises-act-and-its-interim-final-rule-part-i/

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UPCODING MEDICARE: IS HEALTHCARE FRAUD AND ABUSE …

(3 days ago) WEBIntroduction. Medicare fraud has been defined by the Centers for Medicare and Medicaid Services (CMS) as submitted or caused to have been submitted, false …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

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CMS finalizes minimum staffing standards for nursing homes

(9 days ago) WEBThe Centers for Medicare & Medicaid Services April 22 finalized minimum staffing requirements for nursing homes that participate in Medicare and Medicaid. As …

https://www.aha.org/news/headline/2024-04-22-cms-finalizes-minimum-staffing-standards-nursing-homes

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Home Health PPS CMS - Centers for Medicare & Medicaid Services

(6 days ago) WEBBeginning on January 1 2020, HHAs are paid a national, standardized 30-day period payment rate if a period of care meets a certain threshold of home health visits. This …

https://www.cms.gov/medicare/payment/prospective-payment-systems/home-health

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Fact Sheet: Vice President Harris Announces Historic …

(3 days ago) WEBMedicare and Medicaid pay billions of dollars per year to ensure that 1.2 million Americans that receive care in nursing homes are cared for, yet too many nursing …

https://www.whitehouse.gov/briefing-room/statements-releases/2024/04/22/fact-sheet-vice-president-harris-announces-historic-advancements-in-long-term-care-to-support-the-care-economy/

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Is there a downside to mandatory reporting laws meant to protect

(Just Now) WEB: Shots - Health News Colorado is looking at ways to weed out false reporting of child abuse and neglect as the number of reports reaches a record high. New York …

https://www.npr.org/sections/health-shots/2024/04/25/1247021109/states-find-a-downside-to-mandatory-reporting-laws-meant-to-protect-children

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CPT Codes for Case Management, Patient Education, and Other

(6 days ago) WEBBefore initiating services, always verify coverage directly with the payer and notify patients that they may be responsible for payment of non-covered services. On this page: …

https://www.asha.org/practice/reimbursement/coding/CaseManagement/

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The CMS Medicaid Targeted Case Management Brief - CHCS

(3 days ago) WEBBy Sara Rosenbaum, JD, George Washington University School of Public Health and Health Services. T his issue brief examines the CMS targeted case management rule, …

https://www.chcs.org/media/CMS_Medicaid_Targeted_Case_Management_Rule.pdf

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CMS finalizes rules to improve Medicaid, CHIP access and payment

(5 days ago) WEBThe Centers for Medicare & Medicaid Services April 22 finalized rules intended to improve access in both the Medicaid fee-for-service and managed care …

https://www.aha.org/news/headline/2024-04-22-cms-finalizes-rules-improve-medicaid-chip-access-and-payment

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Reforming How Medicare Pays for Digital Health - Bill of Health

(5 days ago) WEBCongress has an opportunity to reform Medicare in 2024, when the Trust Fund will become insolvent. Policymakers expect Congress to address this problem …

https://blog.petrieflom.law.harvard.edu/2021/08/11/medicare-digital-health/

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Home health agencies threaten lawsuits over CMS payment …

(4 days ago) WEBCMS switched up its case-mix system in the the Patient-Driven Groupings Model last year, basing pay rates on patient characteristics like clinical conditions and …

https://www.modernhealthcare.com/payment/home-health-agencies-threaten-lawsuits-over-cms-payment-changes

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TikTok Ban Bill May Survive Courts Despite Free Speech Concerns

(1 days ago) WEBCongress passed a bill this week that will force TikTok's owner to sell its US assets or face removal from mobile-app stores. President Joe Biden signed the bill into …

https://www.businessinsider.com/tiktok-ban-bill-is-first-amendment-disaster-may-survive-courts-2024-4

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Medicaid and Children’s Health Insurance Program Managed Care …

(9 days ago) WEBManaged care is the predominant delivery system in Medicaid and the Children’s Health Insurance Program (CHIP), with over 70% of Medicaid and CHIP …

https://www.cms.gov/newsroom/fact-sheets/medicaid-and-childrens-health-insurance-program-managed-care-access-finance-and-quality-final-rule

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Brown, Collins, Whitehouse Introduce Bipartisan Legislation to …

(8 days ago) WEB“This bipartisan bill would deem time spent in observation status as inpatient care for the purpose of the Medicare three-day prior hospital stay requirement for skilled …

https://www.brown.senate.gov/newsroom/press/release/sherrod-brown-introduce-bipartisan-legislation-protect-seniors-high-costs-necessary-medical-care

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Fact Sheet on FTC’s Proposed Final Noncompete Rule

(6 days ago) WEBReduced health care costs: $74-$194 billion in reduced spending on physician services over the next decade. New business formation: 2.7% increase in the rate of …

https://www.ftc.gov/news-events/news/press-releases/2024/04/fact-sheet-ftcs-proposed-final-noncompete-rule

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New California Rule Aims to Limit Health Care Cost Increases to …

(5 days ago) WEBHealth care spending in the United States has more than doubled in the past two decades, reaching $4.5 trillion in 2022, according to the Centers for Medicare & …

https://www.usnews.com/news/us/articles/2024-04-24/new-california-rule-aims-to-limit-health-care-cost-increases-to-3-annually

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Ohio Senate changes to hospital price bill shock sponsor, advocates

(5 days ago) WEBBill to force Ohio hospitals to detail cost of services gets major changes in Senate A bill to make hospitals publish the actual prices of their services passed the …

https://www.dispatch.com/story/news/politics/2024/04/22/ohio-senate-changes-to-hospital-price-bill-shock-sponsor-advocates/73368551007/

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On Emergency Abortion Access, Justices Seem Sharply Divided

(1 days ago) WEBThe case pits an Idaho law against a federal law requiring hospitals to provide emergency health care. The Idaho law bars doctors from providing abortions unless a …

https://www.nytimes.com/live/2024/04/24/us/abortion-supreme-court-idaho

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Supreme Court appears open to city's crackdown on …

(2 days ago) WEBIn a major case on homelessness, the U.S. Supreme Court on Monday appeared to side with an Oregon city's crackdown on sleeping in public. The decision …

https://www.npr.org/2024/04/22/1245575331/supreme-court-weighs-whether-cities-can-punish-unhoused-people-for-sleeping-outs

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Whitehouse, Brown, & Collins Introduce Bipartisan Legislation to

(6 days ago) WEBWashington, DC – U.S. Senator Sheldon Whitehouse (D-RI) joined Senators Sherrod Brown (D-OH), and Susan Collins (R-ME) to introduce new bipartisan …

https://www.whitehouse.senate.gov/news/release/whitehouse-brown-collins-introduce-bipartisan-legislation-to-protect-seniors-from-high-costs-of-necessary-medical-care/

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MEDICAID DEFINITION OF COVERED CASE MANAGEMENT …

(3 days ago) WEBThe IFC proposes certain refinements and clarifications to Medicaid’s case management benefit that are expected to save the program $1.2 billion over the next …

https://www.cms.gov/newsroom/fact-sheets/medicaid-definition-covered-case-management-services-clarified

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US Supreme Court urged to strike lawyers' $667 mln fee in Blue …

(8 days ago) WEBThe U.S. Supreme Court was asked on Thursday to strike down $667 million in legal fees and costs won by the plaintiffs’ lawyers in a $2.7 billion class-action settlement …

https://www.reuters.com/legal/government/us-supreme-court-urged-strike-lawyers-667-mln-fee-blue-cross-case-2024-04-25/

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Community Health Representatives

(6 days ago) WEBMedicaid Enrollment and Billing Community Health Representatives 2 South Dakota Medicaid recognizes that Community Health Representatives (CHRs) are an …

https://dss.sd.gov/docs/medicaid/general_info/tribal/2024/04.23.24/Community_Health_Representatives_Enrollment_and_Billing.pdf

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Some Older Women Need Extra Breast Scans. Why Won’t …

(9 days ago) WEBMammography can miss tumors in women with dense breasts, so their doctors often include ultrasound or M.R.I. scans. Patients often wind up paying the bill. …

https://www.nytimes.com/2024/04/19/health/dense-breast-mammograms-medicare.html

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Your Billing Responsibilities CMS

(7 days ago) WEBYour Billing Responsibilities. For Medicare programs to work effectively, providers have a significant responsibility for the collection and maintenance of patient information. They …

https://www.cms.gov/medicare/coordination-benefits-recovery/provider-services/your-billing-responsibilities

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