Legal and Regulatory Compliance

New rule sets forth proposed Medicare payment policies for rural emergency hospitals

For hospitals that choose to begin operating under the new rural emergency hospital designation in 2023, Medicare will pay for any service that would be covered as a hospital outpatient department service.

Nick Hut July 21, 2022

CMS says EMTALA covers situations in which terminating a pregnancy is medically necessary

Even in situations that don’t qualify as life-threatening, the Biden administration says patients have the legal right to receive any type of stabilization measure at the discretion of their physician.

Nick Hut July 13, 2022

CMS looks to tweak Medicare conditions of participation for critical access hospitals

A recently issued proposed rule includes a few new conditions of participation for critical access hospitals.

Nick Hut July 7, 2022

Medicare spells out proposed conditions of participation for rural emergency hospitals

Seeking to shore up operations for rural hospitals, CMS issued a proposed rule that establishes recommended regulations for the new rural emergency hospital category.

Nick Hut July 5, 2022

Price transparency update: 6-figure fines have been handed down for hospital noncompliance

The federal price transparency requirements for hospitals entered a new phase this month, with CMS not only issuing the first fines for noncompliance but also publicizing those penalties.

Nick Hut June 23, 2022

Proposed nursing home regulations send an important message to all providers

A statement issued by the Biden administration on Feb. 28 proposed major reforms for the nation’s nursing homes but also has important implications for healthcare organizations of all types.

Paul H. Keckley, PhD May 31, 2022

No Surprises Act

As a result of the 2021 Consolidated Appropriations Act, several No Surprise Billing Act regulations will go into effect on Jan. 1, 2022 for providers, facilities and air ambulance services. These requirements include prohibitions on balance billing for certain items and services, consumer notification and consent requirements for insured patients, cost sharing rules and disclosures, and uninsured/self-pay good faith estimate requirements for scheduled or shoppable items and services.

HFMA May 18, 2022

Some Medicare payments to hospitals for bariatric surgery may be inappropriate, OIG finds

Medicare could have saved nearly $48 million in bariatric surgery payments to hospitals during an 18-month period if coverage rules and guidance were better implemented at the contractor level, according to the HHS Office of Inspector General.

Nick Hut May 17, 2022

Why ensuring the appropriate assignment of observation status patients is so important

Managing observation status requires a focused and consistent effort. Inappropriate assignment of observation status is expensive for patients and hospitals alike and can impede the goal of providing patients with the right care at the right time in the right setting.

Brian Pisarsky April 25, 2022

HHS policy update: Recent developments include an extension of the public health emergency and notable progress in reducing the Medicare appeals backlog

HHS Secretary Xavier Becerra signed a 90-day extension of the COVID-19 public health emergency, ensuring the PHE will last until at least mid-July.

Nick Hut April 18, 2022
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