Physician Medicare Reimbursements

News & Analysis as of

OIG Urges Additional Oversight to Combat Medicare Part D Fraud

Fraud, waste, and abuse in the Medicare Part D prescription drug program continue to threaten the integrity of the program and pose challenges to the federal agencies charged with its administration and oversight. Earlier...more

CMS Releases CY 2016 ESRD PPS Proposed Rule

On June 26, 2015, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule to update the Medicare end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2016. CMS...more

CMS Proposed 2016 Medicare Payment Rules in the Pipeline

CMS recently sent several major proposed Medicare CY 2016 payment rules to the White House Office of Management and Budget (OMB) for regulatory clearance – the last step before publication in the Federal Register....more

It's Time to Bill Medicare: Do You Know Where Your Physicians Are?

The Department of Health and Human Services Office of Inspector General (OIG) recently reported that Medicare contractors overpaid physicians $33.4 million in incorrectly coded physician services between January 2010 and...more

Biosimilars Coding & Reimbursement Significance under Medicare Part B

On April 15, 2015, CMS issued a preliminary recommendation for a HCPCS code for Zarxio, the first biosimilar product ever to be approved by the FDA. CMS’s recommendation provides the first indication of how the agency will...more

Medicare Shared Savings Program - 2015: What's Changed, What's New, and What's to Come?

The most recent Shared Savings Program final rule, published in the Federal Register on June 9, 2015, finalizes a number of the revisions to the original November 2011 final rule that CMS proposed on December 8, 2014. In...more

Consolidation and Conflict in the Health Care Industry

The health care industry has experienced a significant increase in consolidations among providers of facilities and services alike. From drugs to devices to service providers, 2014 saw the largest consolidation within the...more

GAO Criticizes Medicare Physician Payment Ratesetting Process

The Government Accountability Office (GAO) has issued a report pointing out potential shortcomings in the data and process used by CMS to establish the relative values (and consequently the reimbursement levels) for Medicare...more

Blog: Senator Grassley Requests Information Related to Potential Medicare Advantage Fraud

Senator Grassley issued letters this week to the Centers for Medicare and Medicaid Services (CMS) and Department of Justice (DOJ) related to potential fraud in the Medicare Advantage program. Citing news articles, DOJ...more

OIG Flags Overpayments Due to Incorrect Physician Place-of-Service Coding

According to a recent OIG report, "Incorrect Place-of-Service Coding Resulted in Potential Medicare Overpayments Costing Millions,” physicians did not always correctly code the place of service on Part B claims. This...more

Medicare Part B Reimbursement After the SGR Repeal

On April 16, 2015, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 and thereby repealed the sustainable growth rate (“SGR”) Medicare Part B provider reimbursement methodology,...more

21st Century Cures Legislation “Punts” on Telemedicine

On May 13, 2015, the House Energy and Commerce Committee released the latest draft of its 21st Century Cures Legislation. The proposed legislation includes certain telehealth-related provisions that, among other things,...more

SGR Law Creates Merit-based Incentive Payment System and Incentives for Alternative Payment Model Participation

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA” or the “Act”), signed into law by President Barrack Obama on April 16, has been touted as one of the most significant Medicare payment reforms in decades, with...more

Medical Innovation: Congressional Committees Support Accelerated Research and Development for New Drugs, Devices and Biologics

Recent hearings by Senate and House committees and a scheduled markup underscore Congress' continued commitment to eliminating barriers that are slowing the development of effective drugs, devices, and biologics so that...more

Medicare Part D Data Release Continues Transparency Trend

The Centers for Medicare & Medicaid Services (CMS) recently added to the trend toward greater health care data transparency by releasing data about the prescription drugs that physicians and other health care providers...more

CMS Proposes FY 2016 Update to SNF PPS Rates, Policies

On April 20, 2015, CMS published its proposed rule updating Medicare skilled nursing facility (SNF) PPS rates and policies for FY 2016. CMS projects that the proposed rule would increase overall payments to SNFs by $500...more

CMS Releases Proposed FY 2016 Medicare Inpatient Psychiatric Facilities PPS Update

CMS issued a proposed rule on April 24, 2015 that would update FY 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities (IPF) PPS. The proposed rule also would update quality measures and reporting...more

Pending Trade Legislation Would Extend Medicare Sequestration

The House and Senate are considering trade legislation that would be financed in part by $700 million from extended Medicare sequestration authority – much to the consternation of the health care provider community....more

Five Things to Know About the Medicare SGR Fix

H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), was signed into law by President Obama on April 16, 2015. A broad bipartisan compromise measure, MACRA repeals the much-maligned sustainable growth rate (SGR)...more

President Signs Into Law Changes to Medicare Physician Reimbursement Formula

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 ("the Act"). The national headlines about the Act’s passage focused on the repeal of the sustainable growth rate...more

MACRA: Program Integrity and Fraud and Abuse Provisions

On Thursday April 16th, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Pub.L. 114-10. In two previous posts, we discussed MACRA’s repeal of the Sustainable Growth Rate...more

President Obama Signs SGR Repeal Legislation; New Physician Payment Methodology Begins in 2019

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals the Medicare Sustainable Growth Rate (SGR) that was set to cut Medicare Physician Fee...more

Passage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): The “Doc Fix”

The President has signed into law the bipartisan bill H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently repeals the flawed Sustained Growth Rate (SGR) formula and replaces it with a stable...more

The SGR Fix: Congress Charts a New Course for Physician Payments and Gainsharing

On April 16, President Obama signed into law the “Medicare Access and CHIP Reauthorization Act of 2015,” (“MACRA”) which repealed the Sustainable Growth Rate (“SGR”) payment formula used to limit annual updates to Medicare...more

“Doc Fix” Signed into Law; 21% Physician Pay Cut Avoided

President Obama has signed the “doc fix” into law, which permanently avoids a 21% pay cut for physicians that was slated to take effect this April. The law received broad bipartisan support, passing in the House of...more

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