Hospitals and Health Insurers Prodded on Same-Sex and Transgender Issues

In separate actions yesterday, CMS and the New York State insurance regulatory authority took steps to (a) assure equal treatment of same-sex spouses by hospitals and (b) insurance coverage of medically necessary transgender treatment by health insurers. The CMS action took the form of a proposed rule making it …

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CME Payments Exposed to Sunshine, But Not Too Much

Sometimes there’s less to life than meets the eye. Take the final rule issued last Friday by CMS on reporting CME (for continuing medical education) payments under the Physician Payments Sunshine Act. Under that act drug and device manufacturers are generally required to report payments to physicians. But …

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Halloween Announcement of CMS Payment Changes

Maybe it was a coincidence, but CMS waited until Halloween to announce its final 2015 payment policies for physicians and hospital outpatient departments.  While the announced changes are not really scary, one evoked sharp and immediate criticism from the American Medical Association. Generally, overall pay …

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Texas Hospital Qualifies for Exception to Limitation on Exception to Elimination of Exception to Stark Law

Lake Pointe Medical Center has become the first hospital in America to qualify for (i) an exception to (ii) the limitation on the (iii) grandfather exception to the (iv) elimination of the (v) whole-hospital exception to the (vi) Stark Law’s prohibition on physician self-referrals. The Stark Law generally …

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CMS Refuses to Count Family Practice Residents Who Train in Family Practice Settings

Last Friday Eastern Maine Medical Center sued Health & Human Services over the way CMS counted the number of residents in its graduate medical education program.  According to the complaint, CMS refuses to count some of the hospital’s family practice residents. Guess why. Because their training occurred …

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CMS Charges $13 Million Late Payment Fee on $1 Million Medicaid Overpayment

New York City’s Mt. Sinai Hospital refunded a one million dollar Medicaid overpayment. CMS said thanks for the repayment, but you still owe us a late payment fee: $13 million. To add insult to injury, the overpayments were inadvertent—the result of electronic coding errors on about 900 Medicaid claims. On …

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