Leslie Demaree Goldsmith

Transcription

1 LESLIE DEMAREE GOLDSMITH Shareholder is a shareholder in Baker Donelson's Baltimore office. Overview Ms. Goldsmith brings more than 25 years of experience to her practice, representing health care providers such as hospitals, home health agencies and skilled nursing facilities. She provides advice on Medicare and Medicaid reimbursement and regulatory issues involving conditions of payment and conditions of participation. Ms. Goldsmith's diverse experience includes issues involving PPS, provider-based status, wage index, bad debt, quality data, medical education (GME, IME, Nursing and Allied Health), DSH, and cost allocation, as well as billing and claims issues, the Two-Midnight rule, quality reporting, telemedicine, 340B and Medicare bundled payments. She regularly represents clients before the Provider Reimbursement Review Board, CMS Administrator, ALJs and federal courts. Ms. Goldsmith also provides advice on compliance issues related to potential overpayments and the False Claims Act involving alleged improper billing and fraudulent cost reports. Ms. Goldsmith is the author of numerous articles on health care topics that have been published in legal and health care financial journals. She is co-editor of Payment Matters, Baker Ober Health Law's publication on Medicare/Medicaid payment issues. She is a frequent speaker at industry conferences. Nightingale's Health Care News named her one of its ten "Outstanding Hospital Lawyers" for Professional Honors & Activities Professional Memberships Member American Bar Association Member American Health Lawyers Association Member Maryland State Bar Association Community Services Maryland Chapter of the Arthritis Foundation Board of Directors ( ) Public Policy & Advocacy Committee, Chair ( ) Ober Kaler Mentoring Program Co-chair ( ) 1

2 Honoraries Recipient JD Supra Readers' Choice Award - Top Authors in Health Law (2016 and 2017) Selected by Nightingale's Health Care News as one of its ten "Outstanding Hospital Lawyers" (2009) Publications "CMS Softens Physician Inpatient Order Documentation Requirement," Payment Matters (September 2018) "OIG Finds Continued Procedural Errors in Hospital Outlier Payment Reconciliations," Payment Matters (October 2017) "OIG Finds Acute Care Hospitals Improperly Billed for Outpatient Services Provided to Inpatients of Other Hospitals," Payment Matters (October 2017) "Court of Appeals Reverses D.D.C. Order Requiring HHS to Eliminate Medicare Appeals Backlog by December 31, 2020" (September 2017) "CMS Implements Uniform Provider-Based Checklist," Payment Matters (August 2017) "CMS Delays Implementation of Revised HHA Conditions of Participation," Payment Matters (August 2017) "CMS Proposes to Reduce Facility Payment for Non-Excepted Provider-Based Outpatient Department Services by 50 Percent," Payment Matters (August 2017) "Baker's Dozen 13 of the Best Places to Visit in Washington, D.C," Women's Initiative Newsletter (June 2017) Author "Medicare Two-Midnight Rule and Observation Status Updates," Payment Matters (April 2017) Author "Medicare Payment Changes for 'New' Off-Campus, Provider-Based Sites CMS Publishes Final Rule and Congress Provides Some Relief," ABA Health esource, Vol. 13, No. 6 (February 2017) Author "CMS Finalizes Revamped Home Health Agency Conditions of Participation," Payment Matters (January 2017) Chapter Editor "First Ed., Chapter: Medicare Reimbursement Inpatient/Outpatient Hospitals," Representing Hospitals and Health Systems Handbook, American Health Lawyers Association (2016) Author "CMS Publishes the Medicare Outpatient Observation Notice Form and Instructions," Payment Matters (2016) Author "CMS Final Rule and 21st Century Cures Act Include Good and Bad News for ProviderBased Sites," Payment Matters (2016) Author "CMS Releases the 2016 OPPS Final Rule," Payment Matters (2016) Author "Home Health Agency PPS Update for 2017: Quality, Quality, Quality," Payment Matters (2016) 2

3 Author "Court Upholds CMS's Inclusion of Part C Days in the Medicare Fraction of the DSH Calculation for FYE 2012," Payment Matters (2016) Author "D.C. District Court Strikes Down PRRB's Application of the "Self-Disallowance" Jurisdictional Requirement," Payment Matters (2016) Author "The MOON Notification is Coming: CMS Publishes Final Changes," Payment Matters (2016) Author "D.C. District Court Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates," Payment Matters (2016) Author "Court Rules in Favor of Hospitals in Bad Debt Collection Effort," Payment Matters (2016) Author "Final FY 2017 Inpatient Psychiatric Facilities Payment and Policies Rule," Payment Matters (2016) Author "CMS Releases the 2017 IPPS and LTCH PPS Final Rule, Including MOON Requirements," Payment Matters (2016) Co-author "Proposed Cardiac, Hip, and Femur Episode Payment Models Are Next Generation from BPCI and CJR" (August 2016) Author "CMS Releases the 2016 OPPS Proposed Rule," Payment Matters (July 2016) Author "Medicare Appeals Backlog: HHS' Response to the Decade-Long Delay in Reviewing Appeals," Payment Matters (2016) Author "Home Health PPS CY 2017 Proposed Rule: Payments Rebased, Quality Measures Updated," Payment Matters (2016) Author "CMS Announces "Pause" in QIO Review of Inpatient Admissions," Payment Matters (2016) Author "CMS Limits MAC and QIC Scope of Review," Payment Matters (2016) Author "CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways," Payment Matters (2016) Author "Medicare Appeals 10-Year Backlog: D.C. Circuit Signals Enough is Enough," Payment Matters (2016) Author "Court Allows 'Retroactive' Application of 2005 Wage Index Rule Limiting Reimbursement for Pension Plan Costs," Payment Matters (2016) Author "Wage Index Reclassification Rule Struck Down by Second Circuit," Payment Matters (March 2016) Author "Senate Considering Bill to Speed Medicare Claims Appeals," Payment Matters (2016) Author "2-Midnight Rule Updates," Payment Matters (2016) Author "CMS Issues CY 2016 HHA PPS, Value-Based Purchasing and Quality Reporting Final Rule," Payment Matters (2015) 3

4 Author "Court Upholds HHA Face-to-Face Narrative Requirement," Payment Matters (2015) Author "CMS Proposes Significant Revisions to Hospital Discharge Planning Process: How Patient Choice May be Impacted," Payment Matters (November 2015) Author "The Bad Debt Moratorium Requires a Flexible Approach to Evaluating "Reasonable Collection Efforts"," Payment Matters (October 2015) Author "Uncertainty Continues for Two-Midnight Rule's Payment Reduction," Payment Matters (October 2015) Author "Court Upholds CMS Treatment of Multi-Campus Hospitals as Single Entities for Wage Index Purposes," Payment Matters (September 2015) Author "Home Health, CY 2016 Proposed Rule: Emphasis on Value-Based Purchasing," Payment Matters (August 2015) Author "CMS Issues CY 2016 Proposed Rule for OPPS, ASC Payment Systems and Quality Reporting," Payment Matters (July 2015) Author "CMS Proposes Limited Exception to Two-Midnight Rule and QIO Review of Short Stays," Payment Matters (July 2015) Author "CMS Pays $1.3 Billion to Hospitals for Settlements of Medicare Inpatient Appeals," Payment Matters (June 2015) Author "CMS Issues DSH Ruling 1498-R2," Payment Matters (May 2015) Author ""Next Generation" ACO Model Announced by CMS," Payment Matters (April 2015) Author "Beginning April 1, HHA Payment Will Be Determined By CMS Generated Code Using OASIS Data," Payment Matters (March 2015) Author "CMS Proposes Changes to the Medicare Shared Savings Program MSSP," Payment Matters (January 2015) Author "Highlights of the 2015 Home Health Prospective Payment Rule," Payment Matters (December 2014) Author "CMS Releases Final Physician Fee Schedule Rule: Key Payment and Policy Highlights," Payment Matters (November 2014) Author "CMS Releases New, Proposed Home Health Conditions of Participation," Payment Matters (October 2014) Author "Court Affirms CMS's Adjustments to Wage Index," Payment Matters (October 2014) Author "OMHA Announces Two New Programs to Process Administrative Law Judge (ALJ) Hearings More Efficiently," Payment Matters (August 2014) Author "CMS Publishes Proposed 2015 OPPS and ASC Payment Rule," Payment Matters (July 2014) Author "AMA Issues Telemedicine Guidelines," Payment Matters (July 2014) 4

5 Author "CMS Announces Provider Relations Coordinator for RAC and MAC Issues," Payment Matters (July 2014) Author "HHS to Continue Enforcing Orphan Drug Exclusion from 340B Program," Payment Matters (June 2014) Author "Proposed Hospice Rule Focuses on Unbundling of Services," Payment Matters (June 2014) Author "PRRB Issues Alert Requiring Supplementation of Record in DSH Cases," Payment Matters (June 2014) Author "CMS's Proposed Adoption of New Geographic Areas Likely to Have Significant Reimbursement Effects," Payment Matters (May 2014) Co-author "Medicare Bad Debt: Courts Again Uphold HHS's Stringent 'Must Bill' Policy Requirements," Payment Matters (May 2014) Author "AHA Challenges to the Two-Midnight Rule - Preserve Your Hospital's Right to Challenge," Payment Matters (May 2014) Co-author "CMS's New System of Records for the Hospice Quality Reporting Program," Payment Matters, with Danielle M. Moskos (April 2014) Author "Maryland Health Care Commission Proposes to Extend and Revise EHR Incentive Regulations" (April 2014) Author "Upcoming PQRS Deadlines," Payment Matters (March 2014) Author "CMS Posts Guidance on Two-Midnight Rule and Related Audits," Payment Matters (March 2014) Author "CMS Proposes Extensive Emergency Preparedness Rules," Payment Matters (February 2014) Co-author "PQRS Deadline: February 28, 2014," Payment Matters (February 2014) Author "CMS Extends Time for Probe Audits of Inpatient Admissions, and Clarifies Inpatient Order and Certification Requirements," Payment Matters (February 2014) Author "Two Midnight Rule Updates and How to Preserve Rights to Challenge Rule," Payment Matters (January 2014) Co-author "OIG Calls for Increased Scrutiny on Hospital Outlier Payments," Payment Matters (November 2013) Author "CMS Issues Additional Guidance Related to Two-midnight Rule," Payment Matters (November 2013) Co-author "CMS Releases Guidance for MACs on 100% Prepayment and Random Medical Reviews," Payment Matters (November 2013) Author "CMS Issues FAQs for Inpatient '2 Midnight' Rule," Payment Matters (October 2013) 5

6 Speaking Engagements Presenter "OIG Work Plans and Medicare Appeals Update," Regulatory and Reimbursement Update, Northeast Pennsylvania Chapter, Health Financial Management Association (October 2017) Presenter "OIG Work Plans and Medicare Appeals Update," Regulatory and Reimbursement Update, New Jersey Chapter, Healthcare Financial Management Association (September 2017) Presenter "Recent Cost Reporting Appeal Issues PRRB and CMS Administrator Decisions," Institute on Medicare and Medicaid Payment Issues, American Health Lawyers Association ( ) Presenter "Provider-Based Reimbursement Reform," Regulatory and Reimbursement Update, New Jersey Chapter, Healthcare Financial Management Association (2016) Presenter "Current Hot Issues in Medicare Reimbursement," Ninth Annual Fall Institute, Philadelphia Chapter, Healthcare Financial Management Association (2015) Presenter "Medicare Wage Index Update," Institute on Medicare and Medicaid Payment Issues, American Health Lawyers Association ( ) Education Boston University School of Law, J.D., 1987 American Journal of Law & Medicine, Bucknell University, B.A., 1982 Admissions Maryland District of Columbia Court of Appeals of Maryland U.S. Court of Appeals for the District of Columbia Circuit U.S. Court of Appeals for the Eighth Circuit U.S. District Court for the District of Columbia U.S. District Court for the District of Maryland 6