News

A cardiac monitoring company and its subsidiary agreed to a $44.9 million settlement with the Department of Justice (DOJ) following allegations they violated the False Claims Act (FCA) by billing federal programs for heart monitoring services that were knowingly performed outside the US. by unqualified technicians.

The Biden Administration announced Jan. 30 that the COVID-19 public health emergency (PHE) declaration will end on May 11 with the goal of preventing an abrupt end and allowing more than 90 days for healthcare providers to adjust to the operational and financial implications.

Ensemble Health Partners (Ensemble), an industry-leading revenue cycle management company, announced it has been recognized as a top workplace in the country by two national organizations.

CMS recently issued a proposed rule that, among several other revisions, could change utilization management and prior authorization criteria for Medicare Advantage (MA) plans as well as amend the definition of an identified overpayment – both of which could impact providers.

OIG recommended to the Centers for Medicare & Medicaid Services (CMS) that it consider issuing instructions or guidance to the Medicare Administrative Contractors (MACs) that would require or encourage the MACs to more regularly review Medicare bad debts claimed on cost reports.

The Office of Inspector General (OIG) recently issued an advisory opinion in response to a hospital’s request to determine if their arrangement with attending physicians violated the Federal anti-kickback statute. The arrangement in question allows the hospital’s employed nurse practitioners to perform services traditionally performed by a patient’s attending physician.

The hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule was published Nov. 1, 2022, finalizing Medicare payment rates for the 2023 calendar year starting Jan. 1.

Valley Health System and Ensemble Health Partners (“Ensemble”) announced today that they are partnering to optimize the nonprofit health system’s revenue cycle operations.

A recent federal court decision highlights the liability risk providers may face under the False Claims Act (FCA) if they or their vendors do not comply with Medicare bad debt regulations.

Acute care hospitals paid via IPPS and who meaningfully use EHRs can see a 4.3% increase in payment rates that reflect a market basket update of 4.1%, a 25-year high. Additionally, long-term care hospitals (LTCHs) will see an increase of 2.4% or $71 million.