Regulatory Insights Archives

The Addition of Total Knee Arthroplasty (TKA) to the PEPPER Will Be of Little Use to Hospitals

by Dr. Joseph Zebrowitz | Dec 4, 2020 | Regulatory Insights

Much ado is being made about the addition of Total Knee Arthroplasty (TKA) to the Program for Evaluating Payment Patterns Electronic Report or, as we all know it, the PEPPER. I would add my voice to the “ado,” not because I think this indicates coming scrutiny, but...

1135 Waivers: When do they expire?

by Dr. Joseph Zebrowitz | Jun 30, 2020 | Regulatory Insights

These waivers, known as 1135 waivers (due to being granted by Section 1135 of the Social Security Act), are allowed when 2 conditions are met: First, there must be a declaration of a Public Health Emergency (PHE) by the Secretary of the Department of Health and Human...

Medicare Update: Prior Authorization Request Process for Certain Hospital Outpatient Services

by Dr. J. Morrissey | Jun 24, 2020 | Regulatory Insights

Five hospital outpatient department (OPD) services will require prior authorization when provided on or after July 1, 2020. These services include: Blepharoplasty Botulinum toxin injections Panniculectomy Rhinoplasty Vein ablation What is prior authorization as it...

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The Addition of Total Knee Arthroplasty (TKA) to the PEPPER Will Be of Little Use to Hospitals

1135 Waivers: When do they expire?

Medicare Update: Prior Authorization Request Process for Certain Hospital Outpatient Services

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