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 collaborative efforts of the Performing
Continue Reading New York State Receives Passing Grades On Its First DSRIP Report Card

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 to promote better access to
Continue Reading Seeking Interoperability: Centers for Medicare & Medicaid Services

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 number. Incident to services billed
Continue Reading ‘Incident To’ Billing: Billing Physician as the Supervising Physician and Ancillary Personnel Requirements

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 Center, John T. Mather Memorial
Continue Reading CMS to Penalize Hospitals Under Hospital Readmissions Reduction Program

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 for roughly 98% of its


Continue Reading Affordable Care Act: Bundling Payments to Control Costs

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 Claims Act even if the
Continue Reading Medicare Publishes 60-day Repayment Rule

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 on an annual basis. The
Continue Reading New York State Medicaid Providers To Be Reviewed By CMS