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Medicare, Medicaid & Managed Care

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Medicare/Medicaid Fraud & Abuse
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Health care facilities and nursing homes awaiting CMS requirements for staff COVID-19 vaccinations

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2022 Medicare OPPS/ASC Proposed Rule includes updated reimbursement rates, new policies, and reversals of recent policy changes

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CMS proposes changes to Medicare rules governing certain Evaluation and Management visits

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Supreme Court makes certiorari determinations on two Medicare-related cases

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Highlights from the Medicare Program 2022 Proposed Rule for Acute Care Hospitals Inpatient Prospective Payment System

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CMS issues mid-build audit determinations for provider-based locations

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CMS to begin reprocessing hospital claims for 2019 clinic visits provided at excepted off-campus provider-based departments

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Medicare to begin requiring orders for repeat COVID-19 and related tests

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Change of Ownership RAP appeal

Represented a home health agency in its appeal of post-Medicare Change of Ownership Request for Anticipated Payment suspension imposed by the Centers for Medicare and Medicaid Services. Successfully appealed the payment suspension, which was worth $15 million.

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D.C. Circuit upholds Medicare policy of paying hospital outpatient provider-based locations and physician offices the same, reversing lower court

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Medicare to require prior authorization for certain outpatient department services starting July 1, 2020

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