Physicians Centers for Medicare & Medicaid Services

News & Analysis as of

OIG Recommends Eliminating Provider-Based Designation for Facilities Owned by Hospitals

In a report released on June 17, 2016, OIG renewed its call for CMS to either eliminate the provider-based designation, which allows facilities owned by and integrated with a hospital to bill Medicare as a hospital outpatient...more

MACRA will change the way you practice

A recent rule proposed by the Centers for Medicare and Medicaid Services (CMS) will bring far-reaching changes to payment models for physicians and other clinicians (including nurse practitioners, physician assistants,...more

MIPS Performance Scoring: Understanding How CMS Proposes to Calculate Performance Is Key to Preparing for MIPS Participation

On May 9, 2016, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule addressing the implementation of physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015...more

Medicare Makes Changes to the Shared Savings Program to Strengthen Incentives for ACO Care Coordination

On June 6th, the Centers for Medicare & Medicaid Services (CMS) released a final rule shifting how Medicare pays Accountable Care Organizations (ACO) in the Medicare Shared Savings Program. CMS said the final rule aims to...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

Ways and Means Committee Approves Bill to Make Reforms to Medicare Hospital and Other Payment Policies

The House Ways and Means Committee has approved an amended version of H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016.” While most of the provisions address Medicare payment policies pertaining to...more

CMS Corrects Medicare Physician Fee Schedule, Electronic Health Record Incentive Program Final Rules

CMS has published corrections to its November 16, 2015 Medicare physician fee schedule final rule with comment period for 2016, applicable beginning January 1, 2016. Among other things, CMS is correcting an omission of...more

CMS’s Final Medicaid Rule Tweaks the Proposed Rules Related to Marketing, Physician Incentive Arrangements and Long-term Care

On April 25, 2016, the Centers for Medicare & Medicaid Services (CMS), released the Medicaid managed care final rule entitled, “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP...more

CMS Proposes Fiscal Year 2017 Payment for Skilled Nursing Facilities and Provisions for FY 2019 Value-Based Purchasing...

Overall, the Proposed Rule details CMS’s proposals for SNFs in CMS’s accelerating pace of shifting Medicare payment from volume to value toward the administration’s goals and timeline for moving the Medicare program, and the...more

CMS Announces Plans to Streamline the Stark Self-Referral Disclosure Protocol

On May 6, 2016, CMS published a notice (Notice), required under the Paperwork Reduction Act (PRA), seeking public comment on its plans to revise the information collected under the Medicare Self-referral Disclosure Protocol...more

CMS Unveils Revised Voluntary Self-Referral Disclosure Protocol

On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to its Voluntary Self-Referral Disclosure Protocol (SRDP), through which providers may disclose actual or potential violations...more

CMS Proposes Extension of Medicare Self-Referral Disclosure Protocol Lookback Period to Six Years

CMS has published a notice inviting comments on a revised Medicare Self-Referral Disclosure Protocol (SRDP), which is a vehicle for providers and suppliers to voluntarily self-disclose actual or potential violations of the...more

The Future of Medicare Physician Reimbursement: 10 Major Takeaways from the MACRA Proposed Rule

On April 27, 2016, just over a year after the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, the Department of Health and Human Services (HHS) unveiled the long-awaited proposed rule to begin its...more

Also In The News - Health Headlines - May 2016

Senators Proposing Meaningful Use Changes – A group of Republican Senators released proposed legislation that would provide flexibility to hospitals and physicians under the Meaningful Use program. The proposed legislation...more

CMS Proposes Implementation of MACRA Physician Payment Reforms

The Centers for Medicare & Medicaid Services (CMS) has proposed regulations to implement major reforms of the Medicare physician fee schedule (MPFS) update framework that were mandated by the Medicare Access and CHIP...more

Alternative Payment Models (APMs) Under MACRA Proposed Rule

Continuing our blog series on CMS’s massive proposed rule for the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), we dedicate this post to examining the Advance Payment Model (APM)...more

CMS Proposes “Advancing Care Information” Program to Replace Meaningful Use

The Medicare Access and CHIP Reauthorization Act (MACRA) proposes a new approach, with new branding labels, to paying clinicians for the value and the quality of care that they provide by replacing a patchwork of existing...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 Issues MACRA Proposed Rule on Quality Payment Program for Physicians and Other Clinicians

On April 27, 2016, CMS issued a Proposed Rule that would implement certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) to modify the payment system for physicians and other clinicians. ...more

CMS Releases Proposed Rule for MACRA Implementation – Overview and Merit-Based Incentive Payment Systems (MIPS)

On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would put in place key parts of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA impacts a number of...more

CMS Publishes Proposed Rule Implementing MACRA Physician Payment Model

On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) posted a pre-publication version of a proposed rule implementing changes to Medicare payment for physician services authorized under the bipartisan...more

New Part B Drug Payment Model Proposed

On March 11, 2016, CMS proposed implementation of a new two-phase model for drugs reimbursed under Part B of the Medicare Program (“the Proposed Model”). Drugs reimbursed under Part B include drugs administered in hospital...more

CMS Announces Latest Alternative Payment Model - Comprehensive Primary Care Plus

Continuing in its efforts to promote alternative payment models, on April 11, 2016, CMS announced the Comprehensive Primary Care Plus (CPC+) model. CMS hopes to implement CPC+ in up to 20 regions, accommodating up to 5,000...more

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

CMS Announces Major Multi-Payer Comprehensive Primary Care Plus (CPC+) Model

CMS has launched a new “Comprehensive Primary Care Plus” (CPC+) model to improve how primary care is delivered and reimbursed. According to CMS, the CPC+ initiative (which builds on the ongoing Comprehensive Primary Care...more

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