Claims Processing Details Released for AUC Mandate – a Call to Action (continued…)!

By Nathan Baugh
Last month, the Centers for Medicare & Medicaid Services (CMS) released a Medicare Learning Network Article (MLN Matters) detailing certain claims processing aspects of the Appropriate Use Criteria (AUC) Mandate.

On February 20, 2020, CMS revised the MLN Matters article (SE20002) to include a list of additional Qualified Clinical Decision Support Mechanisms (qCDSMs) and their corresponding G-codes which will become effective on 4/1/20.

New Developments in Medicare Enforcement Actions: Impact of Allina

By Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq. of The Health Law Partners, P.C.
Medicare enforcement includes multiple actions, which may range from overpayment demands to enforcement of False Claims Act violations. Such actions oftentimes are predicated not only on a health care provider’s compliance with laws and regulations, but also on its compliance with sub-regulatory guidance.

CMS and OIG Propose Significant Changes to the Stark Law and Anti-Kickback Statute to Remove Barriers as Healthcare Moves to a Value-Based System

By Adrienne Dresevic, Esq. and Arturo Trafny, Esq. of The Health Law Partners, P.C.
On October 9, 2019 the Centers for Medicare & Medicaid Services (CMS), issued a Proposed Rule to Update the Physician Self-Referral (Stark) Law. On the same day, the Office of Inspector General for the Department of Health and Human Services (OIG), issued a Proposed Rule to Update the Anti-Kickback Statute and Civil Monetary Penalty Rules to update the Anti-Kickback Statute (AKS) and the Civil Monetary Penalty law (CMP) regarding beneficiary inducements.