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In a sign that the government is continuing its aggressive search for illegal kickbacks, 2 Philadelphia MRIs plead guilty to paying for referrals.

The owners of two South Jersey MRI facilities pleaded guilty Thursday to paying more than $30,000 to a doctor for patient referrals, according to the U.S. Attorney’s Office. Norman Brettler, 67, of Cherry Hill and Lee Getson, 62, of Southampton each pleaded guilty in Camden federal court to one count of conspiracy to pay kickbacks. Brettler and Getson owned Positioned Imaging Associates in Toms River and Tilton Dynamic Imaging in Northfield. 

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A new study by LDI Senior Fellow Lawton Burns and colleagues challenges the conventional wisdom about the societal benefits and comparative advantages of integrated delivery networks (IDNs). A literature review and detailed analysis of financial and quality indicators found “scant evidence” of improved quality, lower cost per case, or greater societal benefit.

A new study by LDI Senior Fellow Lawton Burns and colleagues challenges the conventional wisdom about the societal benefits and comparative advantages of integrated delivery networks (IDNs).  A literature review and detailed analysis of financial and quality indicators found “scant evidence” of improved quality, lower cost per case, or greater societal benefit. 

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On Friday, March 13th, 2015, CMS issued Transmittal number 7 to the Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10. Transmittal 7 is effective for cost reporting periods ending on or after October 1, 2014.

The transmittal is available at the CMS website: http://www.cms.gov 

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While far from perfect, the attached announcement from CMS makes it clear that imperfection will not lead to complete claims denial.

Practices need to still move forward with implementation and training, and we suggest that all haste be continued, but the CMS announcement indicates that errors of a mild nature won’t create mass rejection of claims.  Practices still need to make sure a proper ICD-10 code is used (even if it turns out it in not the PERFECT code for the diagnosis), but the detail may be off a little and not cause mass denials.  We think it’s a wait and see, as the intermediaries are just getting this information now, as well as the public, but it’s better than nothing.  Plan.  Be Prepared.  Be ready for cash flow disruptions which may still occur.  That’s what the message is today. 

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Taxpayers under examination who are seeking to file a change of accounting method should begin filing this week, based on newly established filing time windows established by a new IRS guidance issued in June 2015. Under new Rev. Proc. 2015-33, taxpayers now have a three-month period in which to file for a change in accounting method and receive audit protection, running from July 15th to October 15th.

In January 2015, the IRS issued Revenue Procedure 2015-13, which changed the rules for companies under examination seeking an accounting method change. (Rev. Proc. 2015-13 "clarifies, modifies and supersedes" Rev. Proc. 2011-14, which was the previous procedure for all accounting method changes). The new procedure changed the rules for when a taxpayer under examination who is filing Form 3115 "Application for Change in Accounting Method" receives audit protection. 

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Two new international trade bills were recently enacted into law last week and another is in the process of reconciliation. The Bipartisan Congressional Trade Priorities and Accountability Act of 2015 and the Trade Preferences Extension Act of 2015 were passed by Congress prior to the July 4th recess. These bills were signed by the President on June 29th. A third trade bill - the Trade Facilitation and Enforcement Act of 2015 - is currently in conference to resolve House and Senate differences.

The enacted bills contain several individual and business tax provisions: 

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The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule [CMS-1633-P] on July 1, 2015.

The CY 2016 OPPS/ASC proposed rule proposes updates to Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings. Approximately 3,800 hospitals and 60 CMHCs are paid under the OPPS, while approximately 5,300 ASCs are paid under the ASC payment system. The OPPS provides payment for most HOPD services, including partial hospitalization services furnished by HOPDs and CMHCs. OPPS payment amounts vary according to the Ambulatory Payment Classification (APC) group to which a service or procedure is assigned. 

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The Affordable Healthcare Act of 2010 ("the Act" or "ACA") prohibits doctor-owned hospitals from expanding, and prevents new doctor-owned hospitals at all, if they are going to serve Medicare or Medicaid patients. The law, passed in 2010, blocked building any new physician owned hospitals and prevented existing ones from adding beds or operating/procedure rooms in order to qualify for Medicare payments.

Hospitals with physician ownership as of March 23, 2010, are grandfathered for the same percentage of physician ownership they had on that day. For example, if a hospital had 20% physician ownership on March 23, 2010, the ACA allows it to keep 20% physician ownership without violating the law, but the percentage of physician ownership cannot increase beyond 20 percent. If the hospital was not yet enrolled in Medicare as of March 23, 2010, it had until December 31, 2010, to enroll and whatever percentage of physician ownership it had at that time was the maximum amount it could have in the future. The ACA bars any new physician ownership in hospitals after December 31, 2010.  

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The Tax Increase Prevention Act (“TIPA”), enacted on December 19, 2014, retroactively extends several tax incentives that expired at the end of 2013. Among the key features of TIPA is a provision extending benefits to eligible investors in Qualified Small Businesses.

Originally enacted in 1993, Internal Revenue Code Section 1202, which covers the Qualified Small Business rules, was intended to encourage investment in small businesses by providing a 50% exclusion of gain resulting from the sale of a qualified small business stock (“QSBS”) held for more than five years.  In order to qualify, the corporation must use at least 80% of the value of its assets in an active conduct of a qualified trade or business, and its aggregate gross assets cannot exceed $50 million after the stock is issued. 

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The Supreme Court yesterday delivered its much anticipated decision in the case of King v Burwell, upholding premium tax credits under the Affordable Care Act (ACA) for taxpayers residing in states which have federal or federal-state Partnership Exchanges. For many, this case presented the strongest argument to upset the ACA, since it was based on the text of the law.

Only 14 states and the District of Columbia have established state Exchanges. Under the law, a state which does not establish its own health Exchange becomes subject to a federal-state partnership or federal-run health insurance Exchange. The statutory language specifically provides that premium tax credits, which help make the health insurance affordable, apply to eligible persons purchasing coverage from their local state Exchange. Since this language does not reference a federal or federal-state partnership Exchange, those opposed to the law argued tax credits could not be provided for insurance purchased from these Exchanges. This position effectively raises the cost of Exchange-based insurance for residents of these states and significantly impacts the overall economic structure of the ACA. 

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