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Advisory Opinion: Clinic Can Provide Free Telemedicine Equipment, Services

A nonprofit, federally qualified health center look-alike (FQHC) can use grant funds to provide telehealth equipment and services for free to facilitate encounters with patients of a county-run clinic that provides testing, treatment and counseling for HIV, based on a recent advisory opinion issued by the Department of Health and Human Services Office of the […]

CMS Policy Changes to Drug Benefit Program Targets Opioid Abuse

Effective June 15, policy changes for the prescription drug benefit program finalized by the Centers for Medicare & Medicaid (CMS) take effect. CMS published the final rule updating Medicare Advantage (MA) and the prescription drug benefit program (Part D).  The new rule is expected to result in nearly $300 million in annual savings over five […]

OIG Opinion: Providing Sample Ostomy Products Does not Violate Anti-Kickback Statute

An ostomy product distributor can give free samples to Medicare patients without worrying about violating the federal Anti-Kickback Statute, according to a recent advisory opinion from the Office of Inspector General for the U.S. Department of Health and Human Services. The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit […]

CMS Wants to Revive Controversial HHA Claim Review Process

The Centers for Medicare & Medicaid Services (CMS) wants to revive a controversial demonstration project for Medicare fee-for-service home health that it says is designed to reduce fraud. What was supposed to be a three-year project, starting in Illinois and expanding to several other states, including Florida, launched in 2016. The idea was for providers […]

Nationwide Push on to Remove Gag from Pharmacists

If some U.S. lawmakers have their way, gag clauses that prohibit pharmacies from telling customers how they can save money on their prescription drugs could be prohibited nationwide, a move that supporters say will result in more transparency and lower costs. On June 20, the Senate Health Committee is set to vote on a bipartisan […]

VA Physicians to Start Practicing Across State Lines

Starting June 11, VA healthcare providers will be allowed to deliver care via telemedicine across state lines. As we wrote about last October, the U.S. Department of Veterans Affairs had issued a proposal that would allow for the provision of telemedicine services, regardless of where providers are licensed to practice. On May 11, the VA […]

OIG Report Critical of AHCA’s Nursing Home Violation Verifications

Florida’s Agency for Health Care Administration (AHCA) is under fire for failing to ensure that nursing homes followed through and properly corrected deficiencies for which they were cited in 2015. A recently released report from the U.S. Department of Health and Human Services Office of the Inspector General (OIG) reviewed 100 deficiencies at nursing homes […]

CMS Issues Slew of New Rules and Policies to Improve Patient Care, Boost Reimbursements

The Centers for Medicare and Medicaid (CMS) has been busy pushing out proposed rules and policy changes that will impact healthcare providers and patients in a variety of ways. Among the proposals it has made is a Data Driven Patient Care Strategy that puts patients at the center of healthcare and makes data more accessible […]

Medical Associations Propose New Payment Model for Opioid Addiction Treatment

Recognizing that the current payment structure for physicians who provide outpatient opioid addiction treatment is not working, the American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) have come up with an alternative payment model. In a recently released 39-page brief, the two medical associations suggest that those treating patients addicted to […]

OIG Report Finds Improper Billing for Telemedicine Services

As the push to increase the use of telemedicine grows, so too do concerns over questionable billing practices. In a recently released report, the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that the Centers for Medicare and Medicaid Services (CMS) paid practitioners for services that did not meet Medicare […]

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