February 2019
Polsinelli is pleased to share the Reimbursement and Payor Dispute Update. This newsletter is a designated source of news, information and guidance on the constantly evolving reimbursement industry.
View the full newsletter here.
In This Issue:
Provider Based Developments
  • Section 603 created bright-line reimbursement rules for hospitals. Excepted provider-based departments would receive full reimbursement under the Outpatient Prospective Payment System (“OPPS”), while nonexcepted facilities’ reimbursement was adjusted downward. 

Under Arrangements

  • Managed Care Companies (“Payors”) have become extremely aggressive within the last few years in filing litigation alleging provider fraud, particularly against laboratories in the toxicology space. The Payors’ allegations revolve around the higher payment rates that hospitals receive for the same lab services than the lab may receive on its own. 

Medicare Audits and Appeals - 2018 Year in Review

  •  This article examines some unique audit and investigation strategies that the OIG, along with CMS and its contractors, employed over the past year. We also look at developments related to the Medicare appeals backlog, and some innovative ways that providers are finding some relief from the historically large appeals backlog. 

2019 Reimbursement Summit

  •  On February 26, 2019, Polsinelli’s Reimbursement Institute will present its Third Annual Reimbursement Summit. Unlike other continuing education events, the Reimbursement Summit allows health care professionals from the general counsel, finance, reimbursement/revenue cycle, operations, and compliance officers to dive deep into key regulatory and reimbursement issues that impact and make or break the success of their health care entities. 

CMS Amends Documentation Requirements and Payment for Evaluation and Management Services

  •  The 2019 Medicare Physician Fee Schedule Final Rule (“the final rule”) announced broad changes to policies governing the Medicare Part B payment of evaluation and management (“E/M”) services delivered in the physician office and outpatient settings.

Upcoming Events

  •  Reimbursement related events and webinars.