New York Whistleblower Court First to Address What It Means to “Identify” Overpayment under ACA’s 60 Day Rule

Posted on January 21, 2015 by BSW

For the first time since its enactment as part of the Affordable Care Act (ACA) in 2010, a federal court in a whistleblower action will consider a provision requiring providers to return overpayments within sixty days of when they are “identified.” The upcoming decision by the United States District Court for the Southern District of New York in U.S. ex rel. Kane v. HealthFirst Inc. et al will likely be just the first of many decisions on the subject. Providers and government regulators are poised for what could prove a lengthy dispute at both the trial and appellate levels around the ACA’s 60 day rule and its interplay with overpayments in the False Claims Act (FCA) context. Continue reading →

ICD-10 Delay Update

Posted on April 3, 2014 by BSW

The house bill (HR 4302) delaying implementation of ICD-10 moved quickly through the Senate on Monday and was signed by President Obama on Tuesday. The ICD-10 delay, which was included in a much broader bill to delay Medicare payment cuts to doctors, prohibits the Centers for Medicare and Medicaid Services (CMS) from enforcing any mandate to switch from ICD-9 to ICD-10 until at least October 1, 2015. Since the language focuses on preventing CMS from enforcing a mandate, several questions remain including whether October 1, 2015 is the new deadline for implementation.

Written by: Traci Thompson

House Passes ICD-10 Delay Bill

Posted on March 31, 2014 by BSW

The U.S. House of Representatives passed a bill on March 27 that would delay the ICD-10 implementation deadline by one year to October 1, 2015. A similar bill in the Senate is expected to be voted on soon. The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, also adjusts Medicare’s sustainable growth rate (SGR) formula to prevent the 24 percent cut to physician reimbursement rates scheduled to begin April 1. Medicare payment cuts to physicians would be delayed until April 1, 2015.

Opposition to the bill focuses on the need for a permanent replacement of the Medicare physician payment system instead of the proposed one year “patch” currently being considered. Opponents of the ICD-10 implementation provision claim that the delay could cost the industry billions of dollars. Others support the measure noting that providers are not prepared for the October 1, 2014 implementation.

Written by: Traci Thompson

The New Two-Midnight Rule – Scrutiny Delayed for 90 Days

Posted on October 7, 2013 by BSW

The Center for Medicare and Medicaid Services (CMS) released what has become known as the “Two Midnight Rule” on August 2, 2013 in the Inpatient Prospective Payment System (IPPS). The Final Rule is available in the August 19, 2013 Federal Register.
Last week, in response to provider concerns and a letter from more than 100 members of Congress asking for postponement of the rule, CMS announced a 90 day implementation period beginning on October 1, 2013. Continue reading →

Overturning of DOMA Has Implications for Medicare Benefits of Same-Sex Couples

Posted on September 3, 2013 by BSW

On Thursday, August 29, in response to the Supreme Court overturning a key portion of the Defense Of Marriage Act (DOMA), a handful of agencies announced they would be extending rights to married same-sex couples. Notably, the Department of Health and Human Services (HHS) is one of them. This development means an extension of Medicare benefits to couples previously denied Medicare benefits because of DOMA. Same-sex married couples will be allowed to file joint federal tax returns, and as a result are able to claim marriage-related exemptions, employee benefits, claiming the earned income tax credit and other credits and deductions even if they live in jurisdictions that don’t recognize same-sex marriage. Continue reading →