Tag Archives: Medicare

ILN Today Post

Overhauling the Medicare Coverage with Evidence Development Guidance Policy? Comments Requested by CMS

On November 7, 2011, the Centers for Medicare & Medicaid Services (“CMS“) issued a public solicitation for comments on the Medicare program’s coverage with evidence development (“CED“) guidance policy. Comments are due by January 6, 2012. In CMS’s most recent solicitation for comments, CMS describes CED as a mechanism “through which we provide conditional payment for items and services while generating clinical data to demonstrate their impact on health outcomes.”[1] We urge all clients interested in Medicare coverage for new items and services to submit comments.

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ILN Today Post

HEALTH REFORM: Health Care Innovation in the Medicare Program: Value-Based Initiatives Beyond Accountable Care Organizations

As the health care industry analyzes the recently released final rule and related guidance regarding the Medicare Shared Savings Program (“MSSP”) for accountable care organizations (“ACOs”) (see Epstein Becker Green’s Implementing Health and Insurance Reform alert of October 27, 2011, here), it is important for the industry to also pay attention to key deadlines related to initiatives being implemented by the Center for Medicare and Medicare Innovation (“CMMI” or “Innovation Center”) within the Centers for Medicare & Medicaid Services (“CMS”).

By way of background, the MSSP is being implemented under the Center for Medicare within CMS. The Innovation Center is a new center organized under CMS, and has a different mission, organizational structure, and leadership than the Center for Medicare. The Innovation Center was created under the 2010 Patient Protection and Affordable Care Act (“ACA”) to test innovative payment and service delivery models to reduce program costs, while also preserving the quality of care for Medicare, Medicaid, and CHIP beneficiaries. Funding in the amount of $10 billion already was provided to the Innovation Center through fiscal year 2019.

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Recent Changes to Medicare Part A Enrollment Forms – Disclosures Required for Certain Financing Sources

Disclosing details of parties with certain mortgages, deeds of trust, or security interests in Medicare Part A providers is explicitly required in the recently revised Medicare enrollment forms, effective as of July 1, 2011. This expanded classification of “ownership interests and/or managing control information” represents a significant change in disclosure, and presents new questions around compliance for Medicare Part A providers and those that finance or are involved in transactions that contemplate mortgages, deeds of trust, and other security interests.

By way of background, Medicare Part A providers (e.g., hospitals, skilled nursing facilities, home health agencies, federally qualified health centers, end-stage renal disease facilities, outpatient rehab facilities) must enroll in the Medicare program using the Medicare Enrollment Application for Institutional Providers (Form CMS-855A) in order to be eligible for payment for covered services provided to beneficiaries. Periodic re-enrollment and timely updating of any change in information is also required using Form CMS-855A. The purpose of the enrollment application is to inform CMS of: (i) the identity of the Part A provider, (ii) whether it meets certain provider qualifications, (iii) where it renders services, (iv) the identity of the owners, and (v) other information to establish correct claims payments.[1]

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ILN Today Post

Elizabeth Sullivan was featured in "Medicare Reimbursement for Beneficiaries with Permanent Pacemakers," published by RBMA

Medicare Reimbursement for Beneficiaries with Permanent Pacemakers

By: Elizabeth Sullivan

The Centers for Medicare & Medicaid Services (CMS) have proposed modifying the current National Coverage Determination Manual to cover reimbursement for MRIs performed on Medicare beneficiaries with permanent pacemakers.

In its Proposed Decision Memo for Magnetic Resonance Imaging (MRI) (CAG – 00399R3) (“Memorandum”), CMS issued the statement that “evidence is adequate to conclude that magnetic resonance imaging (MRI) improves health outcomes for Medicare beneficiaries with implanted permanent pacemakers when . . . used according to the FDA-approved labeling for use in an MRI environment.”

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Hospital Deadline for Medicare EHR Incentive Payments Near

For those hospitals interested in applying for the Medicare EHR Incentive Payments for 2011, the last day to begin the 90-day reporting period is July 3rd.  Hospitals and CAHs must demonstrate meaningful use for 90-days during the 2011 fiscal year (which ends September 30, 2011).  Hospitals and CAHs have until November 30, 2011 to register and […]

For more information please visit www.omwhealthlaw.com or click on the headline above.

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ILN Today Post

HEALTH REFORM: Overview of Methodology for Determining PSA Shares for Accountable Care Organizations Participating in the Medicare Shared Savings Program

On April 19, 2011, the “Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program” (“Proposed Statement”) was published in the Federal Register.[1] The public was given the opportunity to submit comments regarding the Proposed Statement by May 31, 2011.

The Proposed Statement protects Medicare-approved accountable care organizations (“ACOs”) participating in the Medicare Shared Savings Program (“MSSP”) from per seenforcement of the antitrust laws and establishes criteria for evaluating an ACO’s risk of an antitrust law challenge from the Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”) under a “rule of reason” analysis. Among the criteria used to evaluate an ACO’s risk of an antitrust challenge is the ACO applicant’s “market share” within each of its service lines. The market share is a measure of the share of services an ACO participant provides in its Primary Service Area (“PSA”) relative to other providers. The share of services that each ACO participant provides in its PSA – which is referred to as the participant’s “PSA share” – is the key factor that the agencies are proposing to use for determining whether an ACO will receive “Safety Zone” protection from the antitrust laws or be subject to mandatory expedited review from the agencies in order to participate in the MSSP. Consequently, most organizations that are considering forming ACOs will need to calculate the PSA shares of their participant-providers.

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CMS Issues Medicare EHR Incentive Checks

CMS begins writing checks for Medicare EHR Incentive payments.

For more information please visit www.omwhealthlaw.com or click on the headline above.

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Diving into the Federal Issuances Implementing the Medicare Shared Savings Program: A Summary of Topic Areas On Which Government Agencies Specifically Requested Public Comments

by Ross K. Friedberg, Shawn M. Gilman, and Lesley R. Yeung

On March 31, 2011, the Centers for Medicare & Medicaid Services, the Department of Health and Human Services’ Office of the Inspector General, the Federal Trade Commission, the Department of Justice, and the Internal Revenue Service released four separate issuances providing the public with the opportunity to comment on the creation of accountable care organizations eligible for participation in the voluntary Medicare Shared Savings Program (“MSSP”). This alert sets forth a listing of each of the places in which the government agencies specifically request comments from the public. Even those organizations that ultimately may decide not to participate in the MSSP should still take advantage of this unique opportunity to provide these agencies with comments and help shape the modifications being proposed to the Medicare program.

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Making Accountable Care a Reality: Multiple Federal Agencies Issue Proposed Guidance on the Medicare Shared Savings Program

by Shawn M. Gilman, Douglas A. Hastings, Mark E. Lutes, David E. Matyas, Lynn Shapiro Snyder, Carrie Valiant, Dale C. Van Demark, Patricia M. Wagner, and Lesley R. Yeung

On March 31, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released for public comment a much-anticipated Notice of Proposed Rulemaking implementing the voluntary Medicare Shared Savings Program (“Program”) for accountable care organizations (“ACOs”). Also on March 31, the Office of Inspector General, along with CMS, released a Notice with Comment Period to solicit comments regarding proposed waivers from the federal health care program fraud and abuse laws for provider payments made in connection with the Program. On the same day, the Federal Trade Commission and the Department of Justice issued a Notice with Comment Period soliciting comments regarding a “Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program,” and the Internal Revenue Service issued a notice outlining its analysis of tax-exempt organization participation in Medicare ACOs.

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CMS Releases Proposed Rules for Accountable Care Organizations

On March 31, 2011, CMS released its proposed rules for public review and comment relating to Medicare payments for health care providers participating in Accountable Care Organizations (ACOs).

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