Pharmacy Benefit Managers (“PBMs”) continue to scrutinize pharmacies for prescription claims submitted during the coronavirus outbreak (“COVID-19”). Importantly, many PBMs, payors, and governmental bodies including the Center for Medicare... Read More
The pandemic exposed, among other things, some of the shortcomings facing long-term care facilities. Being well-aware of the persistent issues long-term care facilities have with resources, the federal government nevertheless pushed for... Read More
The revocation of enrollment in the Medicare program is an ever-present threat for providers and/or suppliers (“health care providers”). Federal regulations allow the Centers for Medicare & Medicaid Services (“CMS”) to revoke the... Read More
Effective on January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) will implement the Final Rule for Medicare and Medicaid Programs. The Final Rule establishes pharmacy... Read More
Earlier this summer, the Centers for Medicare & Medicaid Services (“CMS”) published the proposed Physician Fee Scheduled (“PFS”) for calendar year 2022, which included several proposed changes affecting telehealth and digital... Read More
The D.C. Circuit issued a ruling earlier this month giving CMS the authority to levy enormous fines against Medicare Advantage carriers for the submission of unsupported patient risk adjustment data to the federal government, laying the groundwork... Read More
As the nation reels from the heartbreaking COVID-19 pandemic, scrutiny of Skilled Nursing Facilities and Long-Term Care facilities is all but certain to continue. Industry leaders and recent data suggests providers anticipate enhanced oversight from... Read More
Early in the COVID-19 outbreak, on April 2, 2020, the Centers for Medicare and Medicaid Services (“CMS”) issued a suspension of most of their audit activities. This suspension was in place until August 5, 2020, when most audit activities... Read More
Providers enrolled in Medicare and/or Medicaid are aware of the myriad of rules associated with coverage for services and the submission of claims, but they are sometimes surprised to learn that neglecting to update their enrollment status and... Read More
Physician groups contracting with government-regulated health plans such as Medicare-Advantage Organizations, Medicaid Managed Care Organizations, or ACA Marketplace Individual/Small Group Issuers often enter into capitated payment models with... Read More
