Fee-for-Service

News & Analysis as of

CMS Releases Unprecedented Amount Of Medicare Billing Information, Increasing Risk Related To Fraud Lawsuits

On April 9, 2014, the Center for Medicare and Medicaid Services ("CMS"), a branch of the Department of Health and Human Services ("HHS"), released data showing utilization, payments, and submitted charges for services and...more

CMS Releases 2012 Physician Medicare Data: Five Takeaways

On April 9, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (the “Data File”). The Data File contains...more

Colorado pilots an integrated model for the Medicare and Medicaid dual-eligible population

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that Colorado is joining its Financial Alignment Initiative to pilot a managed fee-for-service model for people enrolled in both Medicare and Medicaid...more

CMS Proposes Significant Rate Cuts and Other Changes to Medicare Advantage and Prescription Drug Plans

The Advance Notice ("Advance Notice") of Methodological Changes for Calendar Year ("CY") 2015 for Medicare Advantage ("MA") Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter was released by the Centers...more

Polsinelli Podcast - Health Care Payment Changes: From Service to Value [Video]

Healthcare is changing for consumers and providers under the Affordable Care Act. Less publicized is the way providers are now being paid and the way they will work together. In this week's Polsinelli "Inside Law," podcast,...more

A Checklist for Entering Shared Savings Contracts: Practical Considerations

It’s no secret that payment for health care services is moving away from a fee-for-service world that rewards volume towards new value-based models that encourage higher quality and more efficient care. Perhaps no value-based...more

Senate and House Committees Pass Legislation that Would Reform the Sustainable Growth Rate Formula

On December 12, 2013, the Senate Finance Committee and House Ways and Means Committee both approved legislation that would reform the Sustainable Growth Rate (SGR) formula currently used for Medicare physician payments. ...more

Risk-Sharing and Reimbursement of Diagnostic Tests

Five industry executives argue for an overhaul of the current approval and reimbursement framework for diagnostic tests. In A Pay-For-Value, Data-Driven Approach for the Coverage of Innovative Genetic Tests a case is made for...more

Hawaiian Supreme Court Issues Ruling Regarding Restaurant Service Charges

When is a “service charge” a tip? And who gets it, the employer or the employee? These aren’t just questions of etiquette, but are now serious issues for the restaurant and tourism sector in Hawaii....more

CMS Announces CY 2014 MA and Part D Rates with Change to Growth Rate Estimates

The Centers for Medicare & Medicaid Services (CMS) released the announcement of CY 2014 payment rates on April 1, which included its change in position regarding the assumption of the "doc fix" in estimates of Medicare...more

CMS Releases 2014 Advance Notice and Proposed MA and Part D Program MLR Regulations

On February 15, 2013, the Centers for Medicare & Medicaid Services released for comment two key documents affecting the Medicare Advantage (MA) and Part D Programs: (1) the Advance Notice of Methodological Changes for...more

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

On February 5, 2013, CMS sent Congress a report summarizing developments related to its Medicare recovery audit program for fiscal year (FY) 2011. According to the report (titled Recovery Auditing in the Medicare and...more

One-Stop Shop? Court Finds No Violation Of California’s Notary Statute Limiting Fees Charged For “Taking An Acknowledgement” Where...

A California court has confirmed that notaries who provide services additional to notarizations may charge for such services without violating the fee limitations in Government Code § 8211....more

CMS Announces Participants in Bundled Payments for Care Improvement Initiative

On January 31, 2013, CMS announced the organizations that will be participating in its Bundled Payments for Care Improvement (BPCI) initiative. Established under CMS’s innovation authority provided for in the Patient...more

CMS Announces Participants in Bundled Payment Initiative

The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced the health care organizations chosen to participate in the Bundled Payments for Care Improvement (BCPI) Initiative. The BCPI Initiative represents a...more

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