News & Analysis as of

Fee-for-Service

Patient Safety Issues Highlighted in DOJ Settlement and Health Care Industry Cybersecurity Task Force Report

by Pierce Atwood LLP on

As we know, the move away from fee for service reimbursement models is not only intended to reduce costs by no longer paying providers based on the volume of services performed, but is also intended to improve the overall...more

Brave New World: Compliance and the Transition to Value-Based Care

by Ropes & Gray LLP on

The U.S. health care system is in the midst of a fundamental shift, away from traditional “fee-for-service” models that reward providers for the quantity of services provided to patients, toward value-based models designed to...more

Recommendations for Medical Device Manufacturers

by Ropes & Gray LLP on

The U.S. health care system is in the midst of a fundamental shift, away from traditional fee-for-service models that reward providers based upon the volume of services provided to patients, and toward value-based care...more

Manatt on Medicaid: Maine Releases Draft Waiver Request Proposing New Eligibility Requirements

On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more

CMS Delays Effective Date for Episode Payment Model (EPM) Final Rule

by King & Spalding on

CMS has announced that the effective date for the Final Rule for certain EPMs will be delayed until May 20, 2017. This is the second delay for the Final Rule. CMS previously pushed the effective date from February 18 to March...more

CMS makes economics of primary care ACOs more appealing: Smith Anderson

by Smith Anderson on

As you may have read, accountable care organizations have met uneven success over the last several years. But, when they are broken down into categories, physician-sponsored ACOs have done better, particularly those with a...more

Also In The News - Health Headlines - November 2016

by King & Spalding on

CMS Names Latest Round of RAC Contracts – On October 31, 2016, CMS announced it awarded contracts for its Medicare Fee-for-Service Recovery Audit Contractors (RAC) to Performant Recovery, Inc. (Region 1), Cotiviti, LLC...more

The New Era of Health Care Reform

by Locke Lord LLP on

Welcome to the inaugural edition of The New Era of Health Care Reform which highlights important developments in health care reform under the Trump Administration. A FIRST LOOK AT HEALTH CARE PRIORITIES OF...more

Briefing Points for the Board: The Election and the 2017 Health Policy Agenda

by McDermott Will & Emery on

It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and...more

Making Sense of the MACRA Final Rule, Part 1 of 3: Essential Concepts

by Polsinelli on

On Oct. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The nearly 2,400 pages of...more

MACRA: Top 10 FAQs

by Carlton Fields on

Significant changes to the Medicare payment system are underway. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is set to take effect January 1, 2017. MACRA represents a deliberate departure by the...more

Managing the Transition to Transformation: Quality and Payment Reform: Who Is Asking for What and Why?

by McDermott Will & Emery on

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

Republican Lawmakers Voice Concern About Medicare Fraud Prevention

by King & Spalding on

On September 12, 2016, Republican leaders of the House Ways and Means Committee, Energy and Commerce Committee, and Committee on Finance wrote a letter to the acting CMS administrator requesting information regarding CMS’s...more

Manatt on Health Reform: Weekly Highlights - September 2016 #3

Study finds that Marketplace premiums are lower than employer-based premiums, even without federal subsidies; New York regulators move to shield insurers from outsized federal risk adjustment payments; and Missouri will seek...more

CMS Proposes Flexible Reporting Under MACRA

In a blog post last week, CMS acting administrator Andy Slavitt said that physicians will have the ability to choose among several options to report data to Medicare under the new physician payment system ushered in by the...more

Manatt on Health Reform: Weekly Highlights - September 2016 #2

CMS denies Ohio’s Medicaid 1115 waiver request citing the State’s premium proposal; HHS will use 2015 risk corridors collections for remaining 2014 payments; and Alabama closes its Medicaid budget shortfall....more

Managing the Transition to Transformation: Corporate Governance and the Transition to Transformation

by McDermott Will & Emery on

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

Managing the Transition to Transformation: Provider/Payor Integration: 2016 Is Not the 1990s

by McDermott Will & Emery on

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

New Study Finds Medicare Advantage Plans Pay Lower Prices Than Traditional Medicare

A new study by Stanford University researchers finds that Medicare Advantage plans pay lower prices than traditional fee-for-service (FFS) Medicare for most types of hospital admissions. According to the study—published...more

CMS Proposes Sweeping 'Episode Payment Models' for Cardiac Care, Hip/Femur Fracture Cases, Plus Changes to 'Comprehensive Care for...

by Reed Smith on

Proposed Rule to Impact Hundreds of Hospitals and Post-Acute Providers - Building on the current mandatory Comprehensive Care for Joint Replacement (CJR) bundled payment initiative, the Centers for Medicare & Medicaid...more

Managing the Transition to Transformation: Implementing a CJR Collaborator Agreement

by McDermott Will & Emery on

Summary - McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and...more

Managing the Transition to Transformation: Changing the Dynamic: How Alternative Payment Systems Are Changing the Strategic Goals...

by McDermott Will & Emery on

Introduction - The transition of the US health care payment system from fee-for-service (FFS) to alternative value-based, budget-based, episode or procedure-based (e.g., bundled) and/or population-based payment models...more

Roundtable Discussion Results in Senate Committee White Paper on Stark Law Reform

by McDermott Will & Emery on

In Depth - On June 30, 2016, the US Senate Committee on Finance (Committee) released a white paper titled Why Stark, Why Now? Suggestions to Improve the Stark Law to Encourage Innovative Payment Models, that addressed...more

Digital Health: An Improving Environment for Investors

by McDermott Will & Emery on

The integration of technology into health care delivery is exploding throughout the health industry landscape. Commentators speculating on the implications of the information revolution’s penetration of the health care...more

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