Compliance

CMS' new final rule prepares for vaccine coverage for Medicare, Medicaid, and commercial insurers without any out-of-pocket costs. CMS will pay for any coronavirus vaccine that receives FDA authorization either through an Emergency Use Authorization or via a license under a Biologics License Application.

CMS’ most ambitious price transparency requirements go into effect January 1, 2021. Learn how they may have a far-reaching effect on the industry.

CMS finalized the long-awaited Stark Law final rule on November 20. The final rule includes significant changes to exceptions to the law as well as expanded guidance and clarification.

The Office of Inspector General (OIG) is planning to audit hospital inpatient claims for compliance with the 2-midnight rule, according to a recent update to its Work Plan.

CMS’ guidance on the use of modifier -CS may create as many questions as it answers. Learn how to navigate lingering questions and avoid pitfalls.

Q: For the purposes of determining a Medicare overpayment, should claims that we are uncertain whether they were appropriate be included? Is this defined under the False Claims Act (FCA)?

Valerie A. Rinkle, MPA, CHRI, writes about Medicare guidance on and updated payment policies for COVID-19 testing, vaccines, and telehealth services.

CMS extended the timeline for organizations to repay payments received under its Accelerated and Advance Payment program, according to a fact sheet released October 8.

The discovery of an overpayment raises serious questions about compliance requirements. Understand your organization’s reporting obligation and appropriate methods for determining overpayments.

Organizations that received Provider Relief Fund payments of more than $10,000 will be required to report information on how PRF payments were used as well as  expenses related to the novel coronavirus that were not reimbursed (COVID-19), according to new HHS guidance.