Healthcare Law Blog : Medical Groups, Health Plans, Hospital & Facility Lawyers & Attorneys: Sheppard Mullin Law Firm

The Centers for Medicare & Medicaid Services (CMS) recently announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. The large number of participating organizations now exceeds the number of Medicare ACOs, and makes the Bundled Payments initiative the largest voluntary Medicare payment innovation program. Participating organizations are located throughout the United States, and are displayed on CMS’s website.

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The Centers for Medicare and Medicaid Services (CMS) have finally announced the final rule for the Physician Payments Sunshine Act, which will require applicable manufacturers of drugs, devices, biological, or medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report payments or transfers of value provided to physicians or teaching hospitals and require applicable manufacturers and applicable group purchasing organizations to report physician ownership or investment interests. This long-awaited rule has been a subject of frustration for Senators Grassley and Kohl, which was supposed to be implemented in 2012. The final rule will be published in the Federal Register on February 8, 2013, but a pre-publication version is available here. Details on the final rule will be forthcoming on this blog.

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By Eugene Ngai

In a roundtable discussion of the Senate Special Committee on Aging last week, Senators Chuck Grassley and Herb Kohl called on CMS to issue final regulations implementing the Physician Payment Sunshine Act, which was enacted as part of the Affordable Care Act. The Sunshine Act requires certain companies such as pharmaceutical and device companies to report to CMS compensation paid to physicians and teaching hospitals, and any ownership or investment interest owned by physicians. CMS would thereafter publish the data from such reports on a publicly available website. Although data collection was initially supposed to start at the beginning of 2012, CMS has not yet promulgated final regulations, and data collection is not expected to start until 2013 at the earliest. Although CMS published a proposed rule on December 19, 2011, CMS has purportedly struggled with addressing the large volume of public comments. The law contemplated that companies would have 90 days after the final rule was issued to prepare for data collection. If CMS intends to provide companies with a similar amount of time to prepare, it will have to publish a final rule over the next few weeks, or further delay the implementation date for data collection.

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By Karie Rego

Just as you hospitals have their clinicians understanding that they need to specifically order observation services, the MACs and RACs have a new way to deny observation claims. At a recent speech, the Medical Director of the Medicare Administrative Contractor Cahaba (which processes claims for many of the for-profit systems out of Nashville), said that observation orders stating "admit" instead of "referred" to observation would be invalid. The medical director reasoned that there was no such category as an observation patient so therefore a patient cannot be "admitted" to observation.

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By Ken Yood and Lynsey Mitchel

On September 23, 2010, the Centers for Medicare and Medicaid Services ("CMS") released its Voluntary Self-Referral Disclosure Protocol ("SRDP") that healthcare providers and suppliers can use to disclose violations of the physician self-referral statute or Stark Law (Section 1877 of the Social Security Act). The protocol potentially offers promising incentives for self-disclosing, but providers and suppliers must be aware of its attendant risks and burdens. Numerous and complex factors should be considered when a provider contemplates self-disclosing pursuant to the SRDP. 
 

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