News & Analysis as of

Physician Fee Schedule

Health Care E-Note - March 2017

by Burr & Forman on

Like pain clinics and pharmacies, practitioners treating substance use disorder appear to be a target for federal enforcers. Under President Trump's administration and Alabama Attorney General Steve Marshall, law enforcement...more

Will Florida's Crazy PIP Litigation Soon Be a Thing of the Past?

Following an automobile accident, injured parties need immediate funds to pay for medical expenses. To ensure that injured persons have the ability to obtain necessary healthcare, Florida law requires auto insurers to...more

New billing modifier required for services furnished at certain off-campus provider-based departments on or after January 1, 2017

by Dentons on

Changes to Medicare billing and payment rules for services furnished at certain off-campus provider-based departments (PBDs) went into effect on January 1, 2017. Pursuant to the statutory “site-neutral” payment policy enacted...more

Final Rule Implements Quality Payment Program under MACRA

by Baker Ober Health Law on

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

21st Century Cures Act Provides Some Welcome Relief

by Foley & Lardner LLP on

The 21st Century Cures Act (the “Cures Act”) (Pub. L. No. 114-255), which was signed into law by President Obama on December 13, 2016, includes a number of important health care provisions, and several address the...more

2017 Medicare Telehealth Changes

by Tucker Arensberg, P.C. on

The 2017 Medicare Physician Fee Schedule finalizes the CMS changes for Telehealth reimbursement and coverage for 2017. The CMS fee schedule document also provides a comprehensive explanation of Medicare Telehealth...more

Practical Considerations for Medical Practices Considering Converting Their Vascular Access Centers Into Medicare-Certified...

by McGuireWoods LLP on

On November 2, 2016 the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule. Although the impact of the Final Rule on nephrology reimbursement is projected to be...more

Health Law Insights: November Newsletter

by Roetzel & Andress on

ALERT: "No Contract" Disclaimer in Employee Handbook Upheld by Illinois CourtAuthor: Employee handbooks have long been a trap for the unwary employer that desires merely to establish a set of rules and policies without...more

2017 Physician Fee Schedule Includes Clarification of Space and Equipment Rental Exception Under Stark Law

by Roetzel & Andress on

The Department of Health and Human Services Center for Medicaid and Medicaid Services (“CMS”) recently finalized the Calendar Year 2017 Physician Fee Schedule (“2017 Fee Schedule”), which includes a restatement of a provision...more

CMS Reissues Stark Rules Restricting Certain Unit-based Rental Rate Arrangements and Issues Two Stark Updates

by McDermott Will & Emery on

On November 15, 2016, as part of its 2017 Medicare Physician Fee Schedule update, the Center for Medicare and Medicaid Services reissued its prohibition on certain unit-based rental arrangements with referring physicians,...more

Stark Law Updates in 2017 Medicare Physician Fee Schedule Final Rule

by Dorsey & Whitney LLP on

On November 2, the Centers for Medicare & Medicaid Services (CMS) finalized the 2017 Medicare Physician Fee Schedule (PFS) rule. This rule, which takes effect on January 1, 2017, updates payment policies and rates for...more

CMS Finalizes CY 2017 Physician Fee Schedule

by King & Spalding on

On Wednesday, November 2, 2016, CMS issued a final rule (Final Rule) to update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. In the...more

CMS Finalizes Payment Changes for Off-Campus Provider-Based Departments

by Dorsey & Whitney LLP on

The Centers for Medicare & Medicaid Services (CMS) released its 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Final Rule (Final Rule) on Tuesday. The Final Rule...more

CMS Finalizes Changes to the Future of Physician Reimbursement with the Quality Payment Program

by Baker Ober Health Law on

CMS released the Final Rule with comment period delineating a portion of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) known as the Quality Payment Program (QPP) on October 14, 2016, with the official...more

CMS Issues Final MACRA Rule: Expands Exemptions and Flexibility for Smaller Practices

by Roetzel & Andress on

Last Friday, the Center for Medicare and Medicaid Services (“CMS”) issued its Final Rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), which marks a milestone in efforts to improve and...more

PTAC Announces Timeline for Submission of Physician-Focused Alternative Payment Model Proposals

by Reed Smith on

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to provide recommendations on arrangements that meet the criteria for a...more

Lawmakers Join MedPAC in Speaking Out Against CMS Surgeon Data Collection Proposal

by King & Spalding on

On September 16, 2016, approximately 112 congressional representatives submitted a letter to HHS Secretary Sylvia Matthews Burwell and CMS acting Administrator Andy Slavitt requesting that CMS not implement its proposal...more

Medicare Proposes Tiered Outpatient Therapy Evaluation Codes for 2017

by Arnall Golden Gregory LLP on

In July, the Centers for Medicare & Medicaid Services (CMS) announced its intent to add several new codes for physical therapy and occupational therapy evaluation under the Medicare Physician Fee Schedule Proposed Rule for...more

Compliance Concerns Raised Over Proposed Hospital Outpatient Department Rule

by McCarter & English, LLP on

In an August 26, 2016, letter to the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) expressed serious concern over the portion of the calendar year 2017 hospital outpatient prospective...more

Therapy Evaluation Codes Expanded Under CMS' Proposed Rule

by Baker Ober Health Law on

The most significant change for physical and occupational therapists in the Medicare proposed Physician Fee Schedule for 2017 is the replacement of current CPT codes for evaluations and reevaluations. The change reflects the...more

CMS ICD-10 Coding Flexibility Policy to End October 1, 2016. Period.

by Reed Smith on

On October 1, 2016, CMS is definitively ending an ICD-10 coding “flexibility” policy announced last year that prevents practitioner Medicare Part B physician fee schedule claims from being denied based solely on the...more

Proposed 2017 Hospital OPPS Rule Would End Medicare Payments to Many Off Campus Facilities at the Same Levels as Hospital-Based...

by Poyner Spruill LLP on

Published on July 14, 2016, CMS’s proposed 2017 Hospital Outpatient Prospective Payment System (OPPS) rule calls for site-neutral payments that would stop Medicare payments to many off-campus facilities at the same level as...more

Also In The News - Health Headlines - August 2016

by King & Spalding on

CMS Provides Update Regarding Patient Status Review Delay – On July 27, 2016 CMS posted an update regarding Quality Improvement Organization (QIO) reviews of patient status claims, which are currently paused. CMS notes that...more

Provider-Based Rule and Stark—Is Joint Compliance Impossible in 2017?

by Morgan Lewis on

The Centers for Medicare & Medicaid Services (CMS) will be putting hospitals in an untenable position if recent proposed rulemaking is implemented as is. In its proposal for acting on legislation reducing payments to new,...more

CMS Call on MPFS Global Services Data Collection (Aug. 11)

by Reed Smith on

On August 11, 2016, CMS is hosting a call to discuss its plans, set forth in the proposed 2017 Medicare physician fee schedule rule...more

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