The details of the Low Volume Appeals Settlement (LVA) initiative were explained during a Medicare Learning Network Call with CMS on January 9, 2018. The initiative is designed to partially relieve what is now estimated to be a 3-year backlog of claims stacked up for hearings before an Administrative Law […]
Health Law Alert
Billing Labs Not Required to Determine Medical Necessity of Tests
In the recent case, United States ex. rel. Groat v. Boston Heart Diagnostics Corp., decided in December 2017, the U.S. District Court of the District of Columbia held that a laboratory may rely on the ordering physician’s determination of medical necessity in the laboratory’s certification for payment on the CMS-1500 […]
Case Law Update: The Supreme Court Denies Review of the Constitutionality of the Nebraska Hospital Medical Liability Act
In November 2017, we published an article on Schmidt v. Ramsey, a case in which the United States Court of Appeals for the Eight Circuit upheld the constitutionality of the Nebraska Hospital Medical Liability Act (the “Act”). This case involved a claim by the mother of a baby who suffered […]
2018 Final MPFS Rule: Update on Telehealth Services
On November 15, 2017, the Centers for Medicare and Medicaid Services (“CMS”) published the 2018 Final Medicare Physician Fee Schedule Rule (the “MPFS Final Rule”) in the Federal Register. The MPFS Final Rule addresses changes to the Medicare physician fee schedule and other Medicare Part B payment policies, as well […]
Attention, Health Care Institutions: Get Your Affirmative Action Plan in Place ASAP!
As we jump into 2018, health care institutions who receive TRICARE dollars should assess whether those TRICARE dollars are high enough to require them to prepare Affirmative Action Plans (“AAPs”). If they do, they must get their AAPs in place beginning this year, so that they have the requisite information […]