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A Target on Telehealth: Government Action Against Telehealth Fraud in the Wake of COVID-19 | Foley & Lardner LLP

A Target on Telehealth: Government Action Against Telehealth Fraud in the Wake of COVID-19 | Foley & Lardner LLP
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Telehealth Fraud Post-COVID and Subsequent Government Action

Telehealth Fraud Post-COVID and Subsequent Government Action
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CMS begins enforcement of Hospital Price Transparency Rule | Bricker & Eckler LLP

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The Centers for Medicare and Medicaid Services (CMS) has confirmed that the agency began sending warning letters to hospitals it deems out of compliance with the Hospital Price Transparency Rule in April 2021. This represents the first enforcement action under the Rule since it went into effect on January 1, 2021.
In a December 2020 Medicare Learning Network update, CMS stated that it planned to audit a sample of hospitals for compliance with the Rule staring in January and that it would also investigate any complaints it received regarding hospitals not in full compliance with the Rule. CMS previously indicated that enforcement of the Rule would generally occur in the following order: 1) written warning; 2) corrective action plan; and 3) civil monetary penalty. ....

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CMS offers correct billing tips for nonphysician outpatient services provided before or during inpatient stays | Health Care Compliance Association (HCCA)

[6]
“Medicare Does Not Pay Acute-Care Hospitals for Outpatient Services They Provide to Beneficiaries in a Covered Part A Inpatient Stay at Other Facilities (PDF)”
[7]
MLN Matters article.
1 “Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly,” Fast Facts, Medicare Learning Network, Centers for Medicare & Medicaid Services, December 21, 2020, http://go.cms.gov/3ivCwRe.
2 Amy J. Frontz, “Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays,” Office of Inspector General, U.S. Department of Health & Human Services, May 2020, https://go.usa.gov/xvvkt.
3 “FAQs on the 3-Day Payment Window for Services Provided to Outpatients Who Later Are Admitted as Inpatients,” ....

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CMS issues physician fee schedule update | Health Care Compliance Association (HCCA)

[1]
On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS):
Provided a 3.75% increase in MPFS payments for CY 2021
Suspended the 2% payment adjustment (sequestration) through March 31, 2021
Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024
CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) webpage. ....

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