The final 2019 Medicare Physician Fee Schedule released on November 1, 2018 by the Centers for Medicare & Medicaid Services (CMS) includes a section entitled “Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services.” Effective January 1, 2019, physicians may be reimbursed for certain virtual interactions with patients using several new billing codes.

One new

The December 31 deadline for certain Medicaid providers and third-party billers to certify as to the effectiveness of their compliance program is fast approaching.

New York State Medicaid providers and third-party billing companies who claim, bill, order or receive at least $500,000 in any consecutive 12-month period from the Medicaid Program or Managed Medicaid payors

Two dental care companies are the first entities to be placed on the new High Risk – Heightened Scrutiny list created by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) for providers that pose a significant risk to federal healthcare programs and beneficiaries.  Each of the companies settled with the

On Oct. 31, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update the payment system for home health agencies and improve access to remote patient monitoring technology. The rule will allow home health providers to build the costs of remote monitoring technology into their Medicare reimbursement beginning Jan. 1, 2020.

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) announced that certain policy changes in the Medicare Physician Fee Schedule relating to the documentation, coding and payment structure of Evaluation and Management office/outpatient visits will now be delayed until 2021. The changes were originally set to go into effect on January 1,

Healthcare facilities waiting to hear back on Medicare appeals received good news on November 1, when the U.S. District Court for the District of Columbia ordered the U.S. Department of Health and Human Services (HHS) to eliminate its backlog of 426,594 Medicare appeals by 2022. The order, in American Hospital Association, et al., v. Azar,

A federal district court in Illinois, in United States ex rel. Morgan v. Champion Fitness, Inc. et al., No. 1:13-cv-1593 (C.D. Ill, October 19, 2018), recently considered whether the materiality requirement set forth by the U.S. Supreme Court in Universal Health Servs., Inc. v. United States and Massachusetts, ex rel. Escobar, 136 S. Ct. 1989

On October 3, 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. The SUPPORT Act is intended to combat the opioid and heroin crisis by reducing use and supply, encouraging recovery, supporting caregivers and families, and driving innovation and long-term solutions. It also includes the expansion

The Albany Business Review recently held a roundtable event to explore the future of a single-payer system, the rising cost of healthcare and the rapid pace of change in the industry. Rivkin Radler Partner Robert H. Iseman was joined by Barry McNamara, President of employee benefits firm Benetech Inc.; and Kelly K. Smith, Vice President

On October 18, 2018, the New York Court of Appeals struck down a $199,000 cap on executive compensation for healthcare executives, saying the State Department of Health exceeded its authority. The Court upheld a related cap on executive compensation for healthcare organizations that receive state funding.  The case is Leading Age New York Inc. v