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CMS Proposed Revisions to Prescription Drug Benefit Program Met with Opposition

CMS has recently proposed revisions to the Medicare Advantage (MA) Program (Part C) and Prescription Drug Benefit Program (Part D) regulations that will significantly impact sponsors of prescription drug plans, pharmacy benefit managers, pharmacies, and other stakeholders. The proposed rule contains many technical and program changes. One proposed change would reduce the number of protected drug categories from six to three, eliminating the requirement for Part D plan sponsors to...

Potential Bill Would Dramatically Modify In-Office Ancillary Services Exception to Stark Law

Physicians who currently perform pathology services, radiation therapy and services, advanced diagnostic imaging studies, and physical therapy services in their offices should be aware of a new bill that was introduced in August 2013: H.R. 2914, entitled the “Promoting Integrity in Medicare Act of 2013” (PIMA). The bill would majorly curtail the ability to offer several services in-office, and prohibit many common, currently legal arrangements. At present, the federal physician...

Is Your Practice Compliant with the HIPAA Final Rule?

On January 17, 2013, the U.S. Department of Health and Human Services (HHS) issued a new final rule (“Final Rule”) which requires covered entities, a category that includes medical practices, ASCs, ancillary providers, and pharmacies (“Covered Entities”), to significantly modify both their HIPAA compliance plans and agreements with entities with which they conduct business (“Business Associates”). Covered Entities should be aware that the compliance deadline was September 23, 2013; any...

Final Rule Excludes Laboratories from EHR Donation Exception to Stark and Extends Exception Expiration Date

The 2006 Stark exception for Certain Electronic Prescribing and Electronic Health Records Arrangements (EHR Donation Exception), and a 2006 Safe Harbor to the Federal Anti-Kickback Statute allow physicians to receive non-monetary remuneration in the form of electronic health records software (EHR) or information technology and associated training services. CMS and the OIG (the Agencies) issued a Final Rule on December 27, 2013 amending the EHR Donation Exception and extending the sunset date...

Selling Your Medical Practice to a Hospital

In the past year or two, hospitals have been in a feeding frenzy, buying medical practices one after the other. Primary care physicians, cardiologists, ob/gyns and a handful of other specialists have been the targets of these acquisitions. With increasing costs, and sideways or dropping reimbursement rates, hospital offers have been too tempting for some physicians to turn down, and many have made the choice to sell their practice assets...