News & Analysis as of

Physician Payments

Disputing Inaccurate Reports Under the Physician Payment Sunshine Act

by Ruder Ware on

The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical...more

2016 – Health Law Year in Review

We are pleased to present our annual review of developments in the field of health law. The year was marked by key changes in False Claims Act jurisprudence and Medicare payment policy. 2016 also brought with it focused...more

Pick a Lane: CMS Finalizes Two-Track System to Implement Significant Changes in Medicare Physician Payment Policies Under MACRA -...

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has finalized sweeping reforms of the Medicare physician fee schedule (MPFS) update framework, as mandated by Congress last year. While CMS transition policies are intended...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 Releases Much Anticipated MACRA Final Rule

by King & Spalding on

On October 14, 2016, CMS issued its Final Rule for the new physician payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the Medicare Sustainable Growth Rate (SGR) with a new...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

Massachusetts Releases 2017 Acute Hospital Request for Applications and Contract

by Ropes & Gray LLP on

On August 24, 2016, the Massachusetts Executive Office of Health and Human Services (“EOHHS”) released the Rate Year 2017 Acute Hospital Request for Applications and Contract (“RY17 RFA”), which establishes the rates,...more

The Future Is Now: CMS Proposes Broad Bundled Payment Expansion for Cardiac Care Episodes

by Polsinelli on

Furthering the agency’s stated intention to pay for value over volume, the Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule representing the first expansion of mandatory hospital-centric bundled...more

CMS Says MACRA Implementation Will Begin on January 1, 2017 but Physicians Can “Pick Their Pace of Participation”

by King & Spalding on

On September 8, 2016, CMS announced in a blogpost that new physician payment model reforms, established in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will begin implementation on January 1, 2017, as...more

CMS Considers Delaying MACRA Start Date

by King & Spalding on

On July 13, 2016, CMS Acting Administrator Andy Slavitt testified before the Senate Finance Committee regarding the possibility of a delay in implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). ...more

CMS Proposes Amendments to Payments Furnished from Provider-Based Departments

by Polsinelli on

As part of the CY 2017 proposed Hospital Outpatient Prospective Payment System rules (OPPS) the Centers for Medicare and Medicaid Services (CMS) released the long awaited proposed payment changes for items and services...more

Managing the Transition to Transformation: The Strategic Implications of MACRA

by McDermott Will & Emery on

In Depth - On April 27, the Centers for Medicare and Medicaid Services (CMS) unveiled the much-anticipated (and, for some, feared) proposal to implement the physician payment reforms required under the Medicare Access to...more

AMA Demands Appeals Process for Physician Payment Rates

by King & Spalding on

On June 14, 2016, during its annual meeting in Chicago, the American Medical Association’s (AMA) House of Delegates approved a resolution recommending the overhaul of CMS’s physician payment rate determination methodologies,...more

CMS Redefines Alternative Payment Models and Offers Option for Merit-Based Incentive Payment System in New Proposed Rule

The Medicare Access and CHIP Reauthorization Act (MACRA) is expected to drastically change how physicians are paid by the Centers for Medicare and Medicaid Services (CMS). Under the proposed rule, physicians will be given the...more

Physician Payment: CMS Proposes Quality Payment Program, Advanced APMs, and Merit-Based Incentive Payment System

by Baker Ober Health Law on

CMS published its 426 page proposed rule on the Quality Payment Program (QPP) – the successor to oft-maligned Sustainable Growth Rate adjustment – on May 9, 2016. The QPP will adjust physician and mid-level provider...more

Medicare Proposes Sweeping Changes to Physician Payments

by Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) released on April 27, 2016, the highly anticipated proposed rule to implement major Medicare physician payment reform provisions included in the Medicare Access and CHIP...more

Comprehensive Primary Care Plus Model: Today's Alternative Payment Model for Primary Care Providers Could Be Tomorrow's Obligatory...

by Baker Ober Health Law on

In an effort to affect how approximately 25 million Medicare beneficiaries and other commercial insurance patients receive primary care services, the CMS Innovation Center (the "Innovation Center") announced the Comprehensive...more

HHS to Apply Medicare Rates for Physician, Other Health Services Purchased by IHS-Funded Programs

by Holland & Knight LLP on

Sylvia Mathews Burwell, Secretary of the U.S. Department of Health and Human Services (HHS), on March 21, 2016, issued a final rule to apply Medicare payment methodologies to all physician and other health professional...more

CMS Deputy Testifies that Many Alternative Payment Models Would Not be Eligible For Physicians to Receive Incentives Under MACRA

by King & Spalding on

In testimony before the Subcommittee on Health of the U.S. House Committee on Energy & Commerce on March 17, 2016, Dr. Patrick Conway, Deputy Administrator for Innovation and Quality and Chief Medical Officer of CMS,...more

First Meeting of MACRA Physician-Focused Payment Model Technical Advisory Committee Set for Feb. 1, 2016

by Reed Smith on

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) includes payment incentives to encourage providers to participate in alternative payment models (APMs) that focus on coordinating care, improving quality, and...more

Physician Payment: CMS Seeks Suggestions for SGR, PQRS, Meaningful Use and VBM Replacement

by Baker Ober Health Law on

CMS would like your help in developing the replacement to the Sustainable Growth Rate adjustment (SGR). But you need to act quickly because CMS' cutoff date for your suggestions is October 31, 2015....more

CMS Releases Medicare DMEPOS Payment/Utilization Data

by Reed Smith on

In a continuation of the Administration’s efforts to make Medicare spending data more transparent, CMS has released detailed payment information regarding physicians and other providers who order durable medical equipment,...more

Payment Innovation: 30 Day Window to Provide CMS Comments on Physician Payment Changes Under MACRA Begins

by Polsinelli on

On September 28, 2015, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) seeking stakeholder comments related to innovative physician payment models required by the Medicare Access...more

CMS Releases Data Regarding Hospital and Physician Utilization

by McGuireWoods LLP on

CMS recently announced that it would be releasing Medicare hospital utilization and payment data, as well as physician and supplier utilization and payment data. This is the third year that the hospital data has been released...more

CMS Open Payment Program Data Indicates $6.49 Billion Paid by Manufacturers, GPOs to Physicians and Hospitals in 2014

by King & Spalding on

CMS recently released data collected through the Open Payments Program in accordance with the Affordable Care Act from applicable manufacturers and group purchasing organizations (GPOs) about payments and other transfers that...more

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