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After several years of struggles by the Centers for Medicaid and Medicare Services (CMS) to implement a Medicare program requiring the consultation of appropriate use criteria (AUC)...

The Centers for Medicare & Medicaid Services’ proposal for risk adjustment data collection demonstrates the agency’s continued concern that Medicare Advantage Organizations’ activities are resulting in more "intense" coding, and higher risk scores affecting payments, as compared to Medicare fee-for-service.

There has never been a more important time for entities to be diligent in ensuring they have effective compliance programs that can prevent, detect and respond to potential noncompliance issues such as overpayments.

As states attempt to control increasing healthcare costs, many Medicaid programs are seeking approval from the Centers for Medicare & Medicaid Services (CMS) to implement Medicaid managed care programs.

The Centers for Medicare & Medicaid Services (CMS) released survey findings from hundreds of hospital CMS-2567 forms to a nonprofit organization that has posted the information—without responsive plans of correction from the hospitals—on a searchable website.

The topics themselves demonstrate that the information in the Call Letter sets the stage for plans to be very big winners or very big losers.

On July 16, the Centers for Medicare & Medicaid Services (CMS) published the CY 2027 Medicare Physician Fee Schedule proposed rule (91 FR 43842). Citing program integrity concerns, recent Department of Health...

The US Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) published recently its proposed Fiscal Year (FY) 2017 Medicare payment rates and quality program for skilled nursing facilities (SNFs).

Revised New Jersey Executive Directive No. 20-020 Requires Hospitals to Allow Support Person for Pregnant Patients During Labor

On November 14, 2018, the Centers for Medicare & Medicaid Services published a proposed rule that is intended to advance CMS' efforts to relieve perceived regulatory burdens associated with the 2016 Medicaid Managed Care Final Rule

The Centers for Medicare & Medicaid Services (CMS) published new changes to the ACO REACH model to increase predictability for participating ACOs...

In an effort to address the need to increase the availability of COVID-19 testing, the Centers for Medicare & Medicaid Services (CMS) has issued guidance notifying pharmacies...

On March 31, 2023, the US Centers for Medicare & Medicaid Services issued its Announcement of Calendar Year 2024 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies, otherwise known as the Rate Announcement.

On July 7, the Centers for Medicare & Medicaid Services (CMS) published a proposal to cut Medicare Part B payment rates to certain hospitals in the 340B drug pricing program for separately payable drugs purchased...

The American Telemedicine Association (ATA) issued a policy comment letter to the Centers for Medicare and Medicaid Services (CMS), advocating for telehealth-friendly changes to Medicare's telehealth coverage and reimbursement rules.

On July 17, CMS published a press release claiming that 2.8 million Americans were "either enrolled in Medicaid or the Children's Health Insurance Program (CHIP)...

As previously reported by Sheppard, the Centers for Medicare & Medicaid Services ("CMS") has announced several program integrity actions to combat health care fraud.

During the summer months, several developments have occurred concerning the Medicaid Disproportionate Share Hospital (DSH) policy that the Centers for Medicare