INTELLIGENCE
Health Care Reimbursement and Payor Dispute Update
september 2022
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
Co-Location and the Provider-Based Rules – No News is…Good News?
Increased Scrutiny for Provider-Based Facilities
Proposed Updates Impacting Critical Access Hospitals
The No Surprises Act: Unsettled Issues as to Provider Reimbursement
CMS Releases Proposed Rural Emergency Hospital Rules
View the full newsletter here.
Health Care Reimbursement and Payor Dispute Update Special Edition - Year End Regulatory Review
february 2022
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update Special Edition – Year End Regulatory Review. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
CMS Greenlights Teletherapy and Signals Support for Future Telehealth Services
The No Surprises Act: A Final Checklist for 2022
Medicare IPPS Highlights
Provider-Payor Contracting: Increasing State Legislative Efforts Focused on Provider Contracting Practices and Restrictive Provisions
Summary of OPPS/ASC Final Rule
The Coming Storm: Coordination of Benefits for Medicaid Providers
U.S. Supreme Court Hears Rare 340B Drug Pricing Program Matter with Significant Reimbursement Implications
Medicare Physician Fee Schedule
CMS Innovation Center Releases New Strategic Priorities in 2021 to Set Course for Second Decade of Operations
2021 Year in Review: Three Things in the Reimbursement Space That You May Have Missed
Medicare Advantage Review
End of Year SNF PPS Final Rule
2022 Hospice/Home Health Update
End Stage Renal Disease (ESRD) Final Rule
View the full newsletter here.
Health Care Reimbursement and Payor Dispute Update
OCtober 2021
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
Key Takeaways of the Part I Interim Final Rule for the No Surprises Act
How President Biden’s Executive Order Will Promote Competition in Health Care
Changes to CMS’ Final Rule on Pricing Transparency Are Anything But Clear
HHS CARES Provider Relief Fund Updates
Behavioral Health — Provider Considerations for the Evolution to Value-Based Care — Part II
View the full newsletter here.
The Privacy Survival Guide
august 2021
Polsinelli is pleased to share The Privacy Survival Guide. This newsletter is a designated source of news, information and guidance on the constantly evolving health care privacy industry.
In This Issue:
Virginia’s Consumer Data Protection Act
HHS Office for Civil Rights Enforcement Update
21st Century Cures Act Information Blocking Rule: Innovative and In Effect
Past, Present and Future: What’s Happening With Illinois’ and Other Biometric Privacy Laws
Data Localization and Data Transfer Restrictions
View the full newsletter here.
Health Care Reimbursement and Payor Dispute Update
May 2021
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
American Rescue Plan Includes Key Biden Administration Health Priorities
Reimbursement Institute Enforcement Corner
Paused by the Pandemic: CMS Delays Affiliation Disclosure Requirements
New Medicare Provider Type: Rural Emergency Hospital
Behavioral Health — Provider Considerations for the Evolution to Value-Based Care
View the full update here.
Health Care Reimbursement and Payor Dispute Update
FEBRUARY 2021
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
Why Should I Attend the 2021 Reimbursement [Virtual] Summit?
Value-Based Care in 2021: Five Emerging Trends in Value-Based Care
The “No Surprises” Act: Congress Enacts Legislation to End Surprise Medical Billing in Omnibus Year-End Spending Bill
Payors Pick Up Pace in Curbing Preventable Spending on Surgical Care
Who’s Going to Cover COVID Hospitalizations - Commercial Health Plans or Workers’ Compensation?
Physicians and Other Providers Can Now Sue Insurers for Double Damages Under the Medicare Secondary Payer Law
View the full update here.
Polsinelli Healthcare Solutions: Navigating the Illinois Transformation Program
January 2021
On Wednesday, January 13, 2021, the Illinois General Assembly passed House Amendment #3 to Senate Bill 1510 which approves $150 million annually in state Medicaid money for state fiscal years 2021 to 2027 as part of the Illinois Hospital Transformation Program (the “Program”) to fund “innovative partnerships” designed to “establish or improve integrated health care delivery systems that will provide significant access to the Medicaid and uninsured populations in their communities.” The Program is currently under development by the Illinois Department of Health and Family Services (the “Department”) and we expect the Department to begin accepting proposals soon. Collaborations operating in at least one of the most distressed communities in Illinois and areas disproportionately impacted by COVID-19 or collaborations from rural areas of Illinois will be eligible for funds from the Pool. The Department will give priority to partnerships and collaborations that (1) are from distressed communities, and (2) include Business Enterprise Program certified vendors or other entities controlled and managed by minorities or women, and (3) include at least one or more safety net hospitals, critical access hospitals, campuses of hospitals that have closed since January 2018, or other healthcare providers designed to address specific healthcare disparities.
Polsinelli Healthcare Solutions can assist hospitals and other health care providers in applying for and preparing for the Program, including strategic consulting on:
Program eligibility;
Identification and vetting of potential partners based on Program priorities;
Targeted services and approaches;
Coordination of application and program implementation;
Implementing progress monitoring and reporting mechanisms
Proposal development (from strategic concept development to content development and data analysis);
Blueprints for multi-year implementation; and
Integration of proposals into current business strategies and goals.
The Program offers a unique opportunity for health care providers to do well while doing good. Click here to receive more information about how your organization can participate in the Program.
Health Care Reimbursement and Payor Dispute Update Special Edition – Year End Regulatory Review
december 2020
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update Special Edition – Year End Regulatory Review. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
The Centers for Medicare & Medicaid Services Issues New Inpatient Prospective Payment System Final Rule
Three Things Happened in 2020 in the World of Reimbursement Disputes That You Need to Know About
Calendar Year 2021 Outpatient Prospective Payment System Final Rule: What You Need to Know
Payor Contracting
Calendar Year 2021 Final Medicare Physician Fee Schedule Sets Path for Professional Services After Covid-19 Public Health Emergency
Updates to Rules Affecting Inpatient Rehabilitation Facilities, Home Health Agencies, Hospice, Skilled Nursing Facilities, Relative Value Units, and Evaluation and Management Services
The Year in Medicaid
Center for Medicare and Medicaid Innovation
Top Developments in 340B, Drug Pricing and Reimbursement to Watch For in 2021
Medicare Advantage
View the full newsletter here.
Health Care Reimbursement and Payor Dispute Update
october 2020
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
States Move to Make Permanent COVID-19 Telehealth Waivers
Drug Manufacturers Unlawfully Target 340B Program Reductions
Catching Up on Recent Developments Surrounding CARES Act Stimulus Funds
The Intersection of State Escheatment Laws and Patient Credit Balances: Preparing for Increased State Action in the Era of COVID-19
Implementation of Evaluation and Management (“E/M”) Service Payment Creates Uncertainty for Medicare Professional Services Payment and Policy
What Other Reimbursement Changes Occurred While I Was Focused on COVID-19?
Gaps in Payment for COVID-19 Laboratory Testing Plague Providers and Patients
CMS Proposes Expanded Options for Determining “Reasonable and Necessary”
Value-Based Care Comes Full Circle: New CMS Guidance for Medicaid Programs
View the full newsletter here.
Health Care Reimbursement and Payor Dispute Update
August 2020
Polsinelli is pleased to share the Health Care Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
In This Issue:
CMS Reimbursement FAQs — COVID-19
State Court Reverses Medicaid Overpayment Demands
Unemployed and Uninsured: Can Hospitals Cover Patients' COBRA Premiums?
CMS “Hospitals Without Walls” Flexibilities
So You Got Your CARES Check, What’s Next? Preparing for Potential Audits Under Provider Relief Fund Awards
View the full newsletter here.
The Privacy Survival Guide
June 2020
Polsinelli is pleased to share The Privacy Survival Guide. This newsletter is a designated source of news, information and guidance on the constantly evolving health care privacy industry.
In This Issue:
COVID-19 Emergency Exception Under the TCPA
AI in Interviews: What Illinois’ Artificial Intelligence Video Interview Act Means for Employers
HIPAA Update: Lessons Learned from Recent Enforcement Actions
A U.S. National Consumer Privacy Law
Changes to States’ Data Breach Notification Statutes
View the full newsletter here.
340B In The Spotlight – CMS 340B Acquisition Cost Survey Proposal & President’s Budget
February 28, 2020
Kyle A. Vasquez and Julius W. Hobson, Jr.
As predicted, 2020 is already off to a busy start for the 340B Drug Pricing Program.
On February 7, CMS published notice in the Federal Register that it plans to release its outpatient drugs survey (SCOD ACC Survey) to 340B hospitals on March 23, 2020, due 3 weeks later (April 10). Stakeholders have an opportunity to comment regarding the burden estimate or any other aspect of this survey, including the necessity and utility of the proposed information. The 30 day public comment period ends on March 9, 2020.
Most recently, the Administration released the President’s Budget for FY 2021 that provides $34 million (an increase of $24 million obtained through user fees) for HRSA to improve operations and oversight of the 340B program. The budget also proposes to reform the 340B program through the language in the General Provision in the Labor-Health and Human Services-Education Appropriations Act, by providing HRSA the explicit general regulatory authority over the program “to ensure that net income from purchases under the 340B Drug Pricing Program benefit low-income and uninsured patients of the covered entities.”
View the full update here.