CMS Releases Final Medicare Outpatient Observation Notice

The Centers for Medicare & Medicaid Services (“CMS”) posted the final approved version of the Medicare Outpatient Observation Notice (“MOON”) on the CMS Beneficiary Notices Initiative website on December 8, 2016.[1]  According to CMS, all hospitals and critical access hospitals (“CAHs”) are required to provide the MOON beginning no later than March 8, 2017. Continue reading

Medical Malpractice Liability for Management Companies

When can a company that manages a hospital be liable for the medical malpractice of the institution and its physicians?  According to one recent New Mexico decision, when its agents knew of pattern of sub-standard conduct and didn’t act to address it.  The case involved one physician performing experimental surgery on over 100 patients over a period of years.  The decision allowing the claim against the manager was rendered in the hospital’s bankruptcy proceeding, which it filed in an attempt to survive the patients’ claims. Review this article on Insurance News Net for a more complete discussion.

Written by: Greg Frost

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Thinking Outside the Country: Recruiting Foreign Physicians

In recruiting doctors, hospitals must navigate several minefields which include Stark law and the Anti-Kickback Statute. Yet, a rarely considered issue when recruiting physicians is whether immigration laws have been violated. Generally, non-resident aliens who have completed a residency or fellowship training program in the United States must return to their home country for two years before they can work in the United States. Continue reading

CMS Issues Proposed ACO Rule to Address Industry Concerns and Encourage Participation in Alternative Risk-Based ACO Models

On Monday, December 1, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a Proposed Rule with several proposed changes to the regulations finalized in 2011 for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP).  According to CMS, the Proposed Rule is intended to reduce administrative burdens and improve program function and transparency for ACOs participating in the MSSP. There are currently 330 ACOs serving almost 5 million Medicare beneficiaries in 47 states. Continue reading

Presumptive Eligibility has Arrived in Louisiana

Effective January 1, 2014, Louisiana implemented a Presumptive Eligibility program, which allows qualified hospitals to be designated as entities qualified to make presumptive Medicaid eligibility determinations based on primary, self-attested information obtained from individuals seeking medical assistance. Once a hospital determines the presumptive eligibility of a patient, the hospital is guaranteed payment for services that are covered by the state Medicaid plan during a temporary period. If the patient turns out not to be eligible for Medicaid, there is no recoupment of the payments. The program is monitored and executed by the Louisiana Department of Health and Hospitals (“DHH”), which is the designated State Medicaid agency.

Written by: Danielle L. Borel

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