Centers for Medicare & Medicaid Services Health Care Providers

News & Analysis as of

Health Care Outlook for 2016

In 2016, the Affordable Care Act will continue to be a contentious issue involving opposing legislative efforts and presidential debates. It has already been a major talking point in the campaigns of multiple 2016...more

CMS Announces Changes to Medicare Meaningful Use Hardship Exception Application Process

On Jan. 22, 2016, CMS issued a new application and sweeping changes to the Medicare Electronic Health Records (EHR) Incentive Program hardship exception application process. The changes are intended to temporarily ease the...more

CMS Releases Home Health Compare “Patient Experience of Care” Star Ratings

In yet another move emphasizing the Centers for Medicare & Medicaid Services’ (CMS) focus on quality health care, the agency has released the first patient experience of care star ratings on Home Health Compare. ...more

AITN - January 2016

CMS Releases Information on Providers Signed Up For New ACO Models – On January 11, 2016, HHS announced that several providers and hospitals have signed up to join new types of Medicare accountable care organizations (ACOs). ...more

Deadline Looms for EHR Hardship Exceptions

The Centers for Medicare & Medicaid (CMS) expect 209,000 health care providers to face Medicare payment reductions for failing the electronic health records (EHR) “meaningful use” requirements in 2014. CMS puts the estimated...more

Important Changes for Physicians from the 2016 Medicare Physician Fee Schedule: Part I (Stark Changes)

On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (Final MPFS). The Final MPFS addresses changes to the physician fee schedule and related policies,...more

CMS Announces Next Generation ACO Program

On January 11, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the Next Generation ACO program, along with the first group of participants. The program builds on the CMS Pioneer ACO Model and Medicare...more

A&B Healthcare Week in Review - January 2016

On January 5, 2016, the Office of Management and Budget (OMB) received for review a final rule from the Centers for Medicare & Medicaid Services (CMS) entitled Covered Outpatient Drugs (CMS-2345-F). The rule had previously...more

Recent Changes to the Stark Law Provide Added Flexibility

The 2016 Medicare Physician Fee Schedule Final Rule ("Final Rule") contains recent changes to the Federal Stark Law, the majority of which took effect on January 1, 2016. The issuance of the Final Rule on November 16, 2015...more

Final Stark Rule Changes Adopt New Exceptions For Hospitals and Significant Clarifications - Corridors January 2016

In the Medicare Fee Schedule Final Rule with Comment Period for calendar year 2016, the Centers for Medicare & Medicaid Services (CMS) adopted two new exceptions to the Stark physician self-referral law affecting hospitals,...more

CMS Call on IMPACT Act: Connecting Post-Acute Care across the Care Continuum (Feb 4)

On February 4, 2016, CMS is hosting a provider call on Improving Medicare Post-Acute Care Transformation (IMPACT) Act requirements regarding the reporting of standardized patient assessment data by post-acute care (PAC)...more

Catastrophe Averted…What’s Next for ICD-10?

If the October 1, 2015 ICD-10 transition buildup felt to you like Y2K all over again, then you are not alone. Although some hospitals have reported delays in payments, physician practices have not experienced delays in...more

CMS approves $25 billion California Medi-Cal 2020 Demonstration Project

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved a new Section 1115 Demonstration Project for California which could total $24.8 billion over a five year period to serve the uninsured and...more

Also In The News - Health Headlines - December 2015 #2

CMS Releases HAC Data for FY 2016, Showing More Payment Reductions – On December 10, 2015, CMS published quality measure scores related to hospital-acquired conditions (HACs) for hospitals participating in the HAC Reduction...more

Will New Hampshire Offer Medicaid Telehealth Coverage?

A lonely sentence at the end of New Hampshire’s new telemedicine law could mean the Granite State will join 48 other states in offering Medicaid FFS coverage of telehealth services. Interestingly, the very end of the Act...more

2016 Medicare, Medicaid, CHIP Provider Enrollment Application Fee Announced

CMS has announced that the CY 2016 provider enrollment application fee is $554, up slightly from $553 in 2015. This application fee is required for institutional providers that are initially enrolling or revalidating...more

New Law Excludes New Provider-Based Off-Campus Outpatient Hospital Locations from OPPS

On November 2, 2015, President Barack Obama signed into law a bill that significantly changes how Medicare pays for outpatient services furnished at certain hospital locations. The Bipartisan Budget Act of 2015 (“BBA”)...more

Winds of Change Blowing Across the Hospice Landscape

Recent Medicare developments indicate that end-of-life health care providers can expect to face continuing change in an already dynamic sector. These latest turns are part of an ongoing trend toward redefining hospice and...more

Two New Exceptions to Stark to Become Effective in the New Year

Starting January 1, 2016, physicians and certain health care organizations will be able to take advantage of two new exceptions to the physician self-referral law (commonly referred to as the “Stark Law”). Stark contains two...more

Payers Embracing Telemedicine Cost Savings, Ramping Up Reimbursement in 2016

Often considered the primary obstacle to telemedicine implementation, reimbursement changes are now better viewed as one of the most prominent drivers of telemedicine expansion. Payers are finally beginning to realize what...more

Final Stark Law Regulations Published by CMS

As previously discussed here and on our Health Industry Washington Watch blog here the Centers for Medicare & Medicaid Services (CMS) has released final regulations under the physician self-referral law known as the Stark...more

Health Care E-Note - November 2015

With medical device related acquisitions at all-time highs, and regulatory interest intense from the Federal Trade Commission, the Food and Drug Administration, the Securities and Exchange Commission, and the Office of...more

CMS Finalizes Major Changes and Clarification to the Stark Law Regulations

Introduction - Since the passage of the Physician Self-Referral Act, also known as the “Stark Law,” health care providers have had to learn to work within and adjust to certain statutory and regulatory exceptions in...more

District Court Rejects FCA Claim Against Healthcare Provider That Submitted False Claims But Did So Without Necessary Mental State

Healthcare provider Fresenius Medical Care North America claimed victory in a False Claims Act (“FCA”) lawsuit recently when a federal district court ruled that there was no evidence that its practice of billing for...more

Final Rule Issued: Stark Law Modifications Designed to Ease the Burden of Compliance

On October 30, 2015, the Centers for Medicare and Medicaid (“CMS”) issued a final regulation that includes modifications to the Stark Law (the “Final Rule”). Among other things, the Final Rule adds two new exceptions to the...more

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