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President’s budget proposes to “clarify” that the DSH Medicare fraction includes exhausted and MA days

  • King & Spalding LLP
  • -
  • USA
  • -
  • April 15 2013

The President's proposed budget for FY 2014, released last week and available here, includes a line item at page 197 that proposes to "Clarify the

D.C. Circuit holds three-year cost report reopening limitation does not preclude correction of prior year errors’ effects on subsequent years’ payments

  • King & Spalding LLP
  • -
  • USA
  • -
  • March 11 2013

In a decision with potentially far-reaching implications, the U.S. Court of Appeals for the D.C. Circuit ruled last Tuesday that a hospital's

PRRB amends its rules and requires more thorough documentation

  • King & Spalding LLP
  • -
  • USA
  • -
  • March 4 2013

On March 1, 2013, the Provider Reimbursement Review Board (PRRB) amended its rules for the first time since July 1, 2009. The changes are effective

Final state decisions on insurance exchanges

  • King & Spalding LLP
  • -
  • USA
  • -
  • February 18 2013

The final tally is in of State decisions on the establishment of online health insurance marketplaces, or exchanges, with eighteen States agreeing to

CMS and OPM issue proposed rules governing insurance exchanges and multi-state plans

  • King & Spalding LLP
  • -
  • USA
  • -
  • December 3 2012

On Friday, CMS issued a proposed rule offering further details on the operations of the health insurance exchanges established under the health reform law (Exchanges) including the parameters related to the risk adjustment, reinsurance, and risk corridors programs

CMS announces $532 Medicare enrollment fee for 2013

  • King & Spalding LLP
  • -
  • USA
  • -
  • December 3 2012

CMS announced a $532 application fee for calendar year (CY) 2013 for institutional providers that are initially enrolling in the Medicare, Medicaid, or CHIP programs, revalidating their Medicare, Medicaid or CHIP enrollment, or adding a new Medicare practice location

CMS implements statutory reduction to bad debt reimbursements

  • King & Spalding LLP
  • -
  • USA
  • -
  • November 19 2012

In a final rule issued November 9, 2012, CMS implemented the across the board reductions to Medicare’s bad debt reimbursement percentages as prescribed by Sections 3201(a) and (b) of the Middle Class Tax Extension and Job Creation Act of 2012 (Pub

New study suggests VBP Program will have limited affect

  • King & Spalding LLP
  • -
  • USA
  • -
  • September 10 2012

A study appearing in the September 2012 edition of Health Affairs titled “Medicare's New Hospital Value-Based Purchasing Program Is Likely To Have Only A Small Impact On Hospital Payments,” questions “whether the new pay-for-performance program will substantially alter the quality of hospital care”

HHS: Part D premiums steady while donut hole shrinks

  • King & Spalding LLP
  • -
  • USA
  • -
  • August 13 2012

In a press release issued last Monday, HHS predicted that premiums paid by Medicare beneficiaries for Medicare's Part D prescription drug benefit in 2013 will remain level with last year’s premiums, at about $30 per month

New ACO developments announced

  • King & Spalding LLP
  • -
  • USA
  • -
  • July 23 2012

In two new Accountable Care Organization (ACO) developments, 15 of the 89 ACOs recently announced by CMS have been approved as “advance-payment” ACOs, which means they will receive some of their anticipated savings upfront to defray start-up costs, and Cigna has announced new ACO initiatives in six states