Earlier this month the New York State Department of Health released the first results of its recently adopted Medicaid redesign efforts, the Delivery System Reform Incentive Payment (“DSRIP”), in four core areas: (1) metric performance, (2) success of projects, (3) total Medicaid spending and (4) managed care expenditures.   The passing scores stem from the

As we have discussed in an earlier blog post, the federal administrative agencies have been placing greater emphasis on being more transparent and promoting “interoperability”.

As such, on April 24, 2018, the Centers for Medicare & Medicaid Services (“CMS”) proposed changes to its Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System

imagesNG7ROJJTCMS has published a Proposed Rule to clarify how physicians are to bill for services furnished “incident to” the professional services of a physician.

When a medical practice bills Medicare “incident to” for NPP services (i.e. “non-physician practitioners” such as nurses or physician assistants), the bill is rendered by the physician using the physician’s NPI

The Centers for Medicare & Medicaid Services (“CMS”) will be penalizing more than 2,000 hospitals nationwide starting in October 2012 under the Hospital Readmission Reduction Program (the “Program”).  A number of New York hospitals were included on the list of hospitals to which CMS will apply the readmission penalty to reimbursements, including Beth Israel Medical

Now that the Affordable Care Act has been upheld by the U.S. Supreme Court, the requirement to control costs is critical.  One thing we can learn from the experience of near universal coverage in Massachusetts is that providing access to more citizens without containing costs is a recipe for disaster.  In 2006 Massachusetts achieved coverage

The 2010 Patient Protection and Affordable Care Act (“PPACA”) imposed an obligation upon Medicare providers, including physicians, hospitals, nursing homes and home health agencies, to report and return any overpayments they receive within 60 days of identification of the overpayment.  Failure to do so could result in substantial penalties to the provider under the False

Health care providers in New York that participate in Medicaid may be included in the latest cycle of the Centers for Medicare and Medicaid Services Payment Error Rate Measurement Program (“PERM”).  PERM was developed in response to the Improper Payment Information Act, which requires that Federal agencies review programs that are prone to erroneous payments