Regulatory Review

February 26, 2020 Regulatory Review

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.

January 27, 2020 Regulatory Review

Claims Processing Details Released for AUC Mandate – a Call to Action!

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

December 23, 2019 Regulatory Review

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.

October 30, 2019 Regulatory Review

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.

October 7, 2019 Regulatory Review

CMS Issues New Rule to Strengthen the Ability to Stop Fraud

By Adrienne Dresevic, Esq. and Carey Kalmowitz, Esq. of The Health Law Partners, P.C.
The Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the agency’s ability to stop fraud by barring unscrupulous providers from federal health insurance programs. This rule is unlike past rules in that it stops providers before they get paid.