Physician Fee Schedule

News & Analysis as of

ACO Insider: MACRA – Don’t Let Indecision Be Your Biggest Decision

By now, most of us have heard of accountable care organizations and bundled payment. But for many of you, the shift to value-based population health management or compensation based on performance hasn’t affected your...more

Client Alert: CMS Issues Rule Proposing New Approach to Paying Clinicians for Value and Quality

On April 16, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Among other things, MACRA: 1) repealed the Sustainable Growth Rate that was applicable to the Medicare Physician...more

2016 Stark Law Updates

Centers for Medicare and Medicaid Services (CMS) issued the 2016 Medicare Fee Schedule (the "Schedule") in an effort to facilitate compliance with the Physician Self-Referral Law (the "Stark Law"). Generally, absent an...more

CMS’ New Initiative Intended to Transform Primary Health Care

CMS’ efforts to improve the delivery of primary health care moved into new territory this week when the agency announced a new five-year delivery model, Comprehensive Primary Care Plus (CPC+), which CMS’ chief medical officer...more

Telehealth and Medicare: MedPAC Presents Updated Research to the Commission

The status of expanded federal telehealth reimbursement remains uncertain. Continuing an ongoing national policy conversation, the Medicare Payment Advisory Commission (MedPAC) held its second meeting on March 3, 2016, under...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled, “Medicare Program; Part B Drug Payment Model.” The proposed rule seeks...more

Outpatient Therapy Providers - Location Matters

Included in its publication announcing changes for outpatient therapy services in the 2016 Medicare Physician Fee Schedule (MPFS), CMS announced a new requirement for Medicare-certified outpatient therapy providers (e.g.,...more

House Energy and Commerce Committee Seeks Comments on Changes to Provider-Based Status

On Friday, February 5, 2016, key Republican leaders of the House Energy and Commerce Committee solicited comments from healthcare stakeholders – including hospitals – regarding the impact of payment changes for off-campus...more

Portable X-Ray Suppliers Receive Clearer Transportation Billing Guidance

Included among the 2016 Medicare Physician Fee Schedule (MPFS) changes is clarification from CMS regarding how it expects transportation charges billed by portable x-ray suppliers to be prorated among the patients receiving...more

MACRA: What Health Care Providers Need to Know

On April 16, 2015, President Obama signed into law H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA), a bipartisan effort to reform the Medicare payment policy for physician services that adopts a...more

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

On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (Final MPFS).1 The Final MPFS addresses changes to the physician fee schedule and related policies,...more

Health Care E-Note - January 2016

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

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

Stark Law Update

The Stark Law has been updated effective January 1, 2016 in ways that may affect your medical practice and hospital relationships. Among other things, these updates add two new exceptions to the referral prohibition, relax...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

Introducing Stark Phase V

On November 16, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published the most significant changes to the physician self-referral law (“Stark Law”) regulations since 2008. Currently being referred to as...more

Health Law Pulse - January 2016

CHANGES TO STARK LAW, NEW ADVANCE CARE PAYMENTS INCLUDED IN 2016 PHYSICIAN FEE SCHEDULE - The Centers for Medicare & Medicaid Services (CMS) recently published a final rule (Final Rule) regarding physician payment...more

CMS Seeks Comments on Draft Physician Fee Schedule Quality Measure Development Plan

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to develop quality measures that will apply to Medicare payments to physicians when new Merit-based Incentive Payment System (MIPS) and Medicare...more

Patient Access and Medicare Protection Act Signed Into Law; Includes Additional Medicare Reforms

On December 28, 2015, President Obama signed into law S. 2425, the Patient Access and Medicare Protection Act, which includes a number of Medicare provisions that were not included in the Consolidated Appropriations Act. ...more

Don’t Mail That Overpayment Disclosure Just Yet: Implications of CMS’ Final Rule Expanding the Writing, Signature and Holdover...

The Centers for Medicare and Medicaid Services (CMS) on Nov. 16, 20151 published the calendar year 2016 physician fee schedule final rule, fundamentally reducing the burden on entities seeking to demonstrate compliance with...more

Stark Updates Included in Final 2016 Physician Fee Schedule

With the final Medicare physician fee schedule (PFS) for 2016, the Centers for Medicare and Medicaid Services (CMS) has made a series of updates to the Stark physician self-referral regulations. The final rule is largely...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

Recent Provider-Based Legislative Changes: Any GME Implications?

On November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015, among other things, making changes to Medicare reimbursement for outpatient services furnished in off-campus provider-based departments...more

CMS Issues Final Payment Rules for Physicians and Hospitals

On October 30, 2015, the U.S. Department of Health and Human Services (HHS) released several final rules related to physician and hospital Medicare payments for 2016. Specifically, HHS’s Centers for Medicare and Medicaid...more

CMS Finalizes Stark Law Changes in CY 2016 Medicare Physician Fee Schedule Final Rule

This past July, on the heels of a decision in which a judge for the U.S. Court of Appeals for the Fourth Circuit characterized the federal physician self-referral prohibition commonly known as the “Stark Law” as, “even for...more

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