On April 11th, 2022, New York became one of 25 U.S. states to grant permanent full practice authority to Nurse Practitioners (NP). The 2022 State of the State proposal additionally allows NPs with more than 3,600 hours of experience to practice without a contractual practice-agreement relationship with a doctor. With full practice authority, nurse practitioners […]
On February 23, 2022, the United States District Court for the Eastern District of Texas, Tyler Division, issued a Memorandum Opinion and Order,[1] which served to strike down certain portions of the federal No Surprises Act (“NSA”) related to the independent dispute resolution (“IDR”) process for resolving payment disputes between out-of-network providers and group health […]
In June 2021, the Occupational Safety and Health Administration (“OSHA”) issued an Emergency Temporary Standard (“ETS”) that would require, amongst other things, employers with 100 or more employees to adopt a mandatory COVID-19 vaccination policy. OSHA’s mandatory vaccination policy would affect approximately 84 million employees. An overview of the OSHA Vaccine Policy requirements can be […]
On September 18th, a panel of the Fifth Circuit affirmed a lower court ruling denying injunctive relief against recoupment for Medicare providers still faced with an overpayment demand after going through the first two steps of the administrative review process. In affirming the lower court’s decision, the Fifth Circuit affirmed that the government had provided […]
The Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) recently released the Health Care Fraud and Abuse Control Program Annual Report for 2019 (the “Report”). The Report provides an overview of the joint effort of the HHS and DOJ in identifying and prosecuting health care fraud in Fiscal Year 2019. […]
The Department of Labor (DOL) recently issued a temporary rule (the “Revised Rule”) that revised the regulations implementing the Families First Coronavirus Response Act (“FFCRA”). These revisions went into effect on September 16, 2020. By way of background, the FFCRA created two new emergency paid leave requirements, the Emergency Family and Medical Leave Expansion Act […]
The U.S. Department of Health and Human Services Office of Inspector General (OIG) has recently issued a report regarding overpayment reviews by Medicare Administrative Contractors (MACs). The OIG’s report determined that MACs have been inconsistent in reviewing extrapolated overpayments during the provider appeals process. These inconsistencies have resulted in at least $42 million in extrapolated […]
On August 3, 2020, two issues were approved for review and posted on the Centers for Medicare & Medicaid Services (CMS) Recovery Audit program website: 0184 – Total Hip Arthroplasty: Medical Necessity and Documentation Requirements, and 0185 – Total Knee Arthroplasty: Medical Necessity and Documentation Requirements. In particular, the approved issues involve whether the documentation […]
The Office of Medicare Hearings and Appeals (OMHA) has recently opened the Settlement Conference Facilitation (SCF) to the appellant community. The SCF is an alternative dispute resolution (ADR) process meant to bring certain providers and the Centers for Medicare & Medicaid Services (CMS) together to discuss mutually agreeable resolutions for Medicare Part A and B […]
The Centers for Medicare and Medicaid Services (CMS) has issued two new proposed rules. First, CMS has issued a proposed rule for the 2021 Medicare Physician Fee Schedule (PFS Proposed Rule). The rule will be published on August 17, 2020. You can access the unpublished version here. Second, CMS issued a proposed rule for the […]
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