Medicare-Enrolled Providers And Suppliers To Revalidate By 2015

by Jeanne L. Vance
The Healthcare Law Blog

The Centers for Medicare & Medicaid Services (“CMS”) has begun the process of revalidating most Medicare provider and supplier enrollments, which must be completed by 2015. This effort began making waves in the provider and supplier community when letters sent last fall from the Medicare Administrative Contractors (“MACs”) gave recipients 60 days to respond with a complete Medicare revalidation application. The consequences of failure to comply with a MAC request to revalidate include deactivation of a provider or supplier’s enrollment,

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CMS Finalizes 2012 Skilled Nursing Facility Payment Changes

by Jeanne L. Vance
The Healthcare Law Blog

The Centers for Medicare & Medicaid Services (CMS) finalized changes for Medicare skilled nursing facility (SNF) payments for calendar year (CY) 2012. The final rule will be published in the August 8, 2011, Federal Register. CMS finalized an 11.1% decrease to SNF Medicare payments, reflecting the net effects of a downward recalibration of case-mix indexes, a market basket increase and a multi-factor productivity adjustment to the SNF prospective payment system (PPS) rates. In addition, CMS revised several SNF payment policies effective October 1,

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CMS Proposes HOPDAnd ASC Payment Policy And Rate Updates For 2012

by Jeanne L. Vance
The Healthcare Law Blog

On July 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule with policy and payment changes for Hospital Outpatient Departments (HOPDs) and Ambulatory Surgical Centers (ASCs). The proposed rule would affect Medicare payments commencing in calendar year (CY) 2012. The proposed rule will be published in the July 18, 2011, Federal Register.

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CMS Issues Proposed 2012 Physician Fee Schedule

by Jeanne L. Vance
The Healthcare Law Blog

On July 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued proposed payment rate and policy changes for the Medicare physician fee schedule that would go into effect for calendar year (CY) 2012. The proposed rule will be published in the July 19, 2011, Federal Register. Highlights of the proposed changes are discussed below. Note that the proposed rule does not address CMS’ projected reduction of 29.5% to the conversion factor for CY 2012 that is based on the application of the sustainable growth rate (SGR).

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Medi-Cal Enrollment Fees Go Into Effect Today! Dhcs Failure To Issue Implementing Instructions Leaves Providers With Questions

by Jeanne L. Vance

Starting today, Department of Health Care Services (“DHCS”) is required to collect Medi-Cal enrollment fees of $505 per enrollment for “institutional providers.” DHCS Provider Enrollment Unit has issued no formal guidance regarding how it will implement the new requirements, and requests for information guidance from DHCS’ Acting Chief of Provider Enrollment have revealed few details regarding how a provider can comply with the new requirements.

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Initial Enrollments And Changes Of Ownership Impacted By Home Health Medicare Enrollment Rule Changes

by Jeanne L. Vance

In the March 2011 edition of The Rap Sheet, Weintraub attorney Jeanne Vance writes the Centers for Medicare & Medicaid Services (CMS) modified home health agency (HHA) Medicare provider enrollment provisions in two important ways. First, it extended the amount of time that a Medicare-certified HHA must meet initial capitalization requirements. Second, it narrowed the scope of business transactions that are subject to the so-called 36-Month Rule, which causes the deactivation of an HHA’s Medicare billing entitlements upon the occurrence of certain HHA ownership transfers that occur within three years of the last ownership change.

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CMS Issues Proposed Rule To Implement Provider Enrollment Aspects Of Affordable Care Act

by Jeanne L. Vance

The Centers for Medicare & Medicaid Services (“CMS”) recently published proposed regulations that would implement provisions of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Affordable Care Act”) relating to provider enrollment in Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”). Published in the September 23, 2010 Federal Register, the proposed rules, if adopted, would introduce fingerprinting to the public-program enrollment process,

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