HHS’ Office of Inspector General recently released a report detailing vulnerabilities in CMS’ oversight of billing at provider-based facilities. The report investigated a random sample of 333 ...

Bolstered by the Supreme Court's landmark decision in National Federation of Independent Business v. Sebelius, 132 S.Ct. 2566 (June 28, 2012), the movement toward affiliation as a means of improving ...

Last year, Congress passed legislation to reduce Medicare provider-based reimbursements at outpatient facilities and eliminate the reimbursements at off-campus hospital facilities acquired after Nov.

Medicare reimbursement for off-campus hospital outpatient departments is once again under attack. Effective January 1, 2028, Section 6225 of the Consolidated Appropriations Act, 2026 ("CAA") will ...

The submission of an attestation to a hospital’s and its off-campus outpatient department’s compliance with Medicare’s provider-based rules has long been voluntary under the Centers for Medicare & ...

That proposed rule primarily sought to revise 38 CFR 17.101 to remove the regulatory requirement that VA use the Centers for Medicare and Medical Services (CMS) provider-based criteria with regards to ...

Provider-based billing was introduced in 2000 to improve access to care for patients on Medicaid and charity care. At the time, some physician practices limited or refused appointments for these ...