Physicians Centers for Medicare & Medicaid Services

News & Analysis as of

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

OIG Examines Hospice Medicare Billing for General Inpatient Care

According to a recent OIG report, hospices billed inappropriately almost one-third of Medicare general inpatient care (GIP) stays in 2012, resulting in $268 million in inappropriate Medicare payments. The GIP level of care...more

CMS Call on 2016 PQRS Reporting & Avoiding 2018 Negative Payment Adjustments

On April 21, 2016, CMS is hosting a provider call on the 2016 Physician Quality Reporting System (PQRS), including how eligible professionals and group practices can satisfactorily participate and report in order to avoid the...more

CMS Moving Ahead on Medicare Physician Payment Reform; Proposed MACRA Rule at OMB

The White House Office of Management and Budget (OMB) is now reviewing a highly-anticipated Centers for Medicare & Medicaid Services’ (CMS) proposed rule to implement major Medicare physician payment reform provisions...more

CMS Call on Opportunity to Review Open Payments/Sunshine Act Data (April 12)

CMS is hosting a provider call on April 12, 2016 to discuss the Open Payments program, including the process for physicians and teaching hospitals to review applicable data on payments or transfers of value prior to...more

CMS Delays Enforcement of Medicare Part D Prescriber Enrollment Requirement Until February 1, 2017

CMS is delaying until February 1, 2017 enforcement of previously-adopted regulations that require physicians and other eligible professionals who prescribe Part D drugs to be enrolled in Medicare (or have a valid opt-out...more

All Right Stop, Collaborate and Listen! CMS Is Back with Its Brand New Invention, Preparing for CJR Gainsharing

Understandably, there is anticipation surrounding the April 1st start date for CMS’s newest bundled payment program, the Comprehensive Care for Joint Replacement (CJR) program. As participant hospitals consider gainsharing...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 15, 2016, the Centers for Disease Control and Prevention (CDC) issued voluntary guidelines entitled, “CDC Guidelines for Prescribing Opioids for Chronic Pain — United...more

Analysis of New Timeshare Arrangement Exception to the Stark Law – Part 1

On July 15, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed a series of rules that would create new exceptions to the Stark law, in addition to clarifying other provisions of the Stark law. One of the newly...more

Also in The News - Health Headlines - February 2016 #2

ALSO IN THE NEWS: CMS Extends Deadline for Hardship Exception Applications – On February 26, 2016, CMS updated its online instructions for submitting a hardship exception application to reflect that hardship exception...more

CMS, AHIP Release Multi-Payer Physician Quality Measure Sets

CMS and America’s Health Insurance Plans (AHIP) recently released seven sets of physician clinical quality measures as part of a “Core Quality Measures Collaborative” intended to align quality measures among payers and reduce...more

Health Care Update - February 2016 #4

What to Expect from Congress this Work Period - The next Hill work period basically runs from February 22nd to March 23rd. As Congress returns, here’s a brief look at the pending health care issues on the radar for this...more

King & Spalding Submits Comments to CMS Regarding Two-Midnight Rule, Rejecting Agency’s Latest Rationale for Payment Reduction

On February 2, 2016, on behalf of more than 200 client hospitals, King & Spalding responded to CMS’s latest justification for its two-midnight rule and associated 0.2 percent payment reduction, published at 80 Fed. Reg. 75107...more

Private Equity Market Intelligence: Physician/Hospital Quarterly Report - Q4

Key Findings - ..ACA enrollment reached 11.3 million by the end of the third open enrollment period, surpassing HHS expectations. Three-quarters of the enrollees were from the 38 states that use the healthcare.gov...more

CMS Signals that Meaningful Use Program Will Change Significantly for Physicians

On January 11, 2016, CMS Administrator Andy Slavitt announced that the Medicare Electronic Health Record Incentive Program will be replaced significantly in 2017 by the new Merit-Based Incentive Payment System (MIPS) for...more

Catastrophe Averted…What’s Next for ICD-10?

If the October 1, 2015 ICD-10 transition buildup felt to you like Y2K all over again, then you are not alone. Although some hospitals have reported delays in payments, physician practices have not experienced delays in...more

GAO Recommends Payment Reform in Response to Increase in Hospital/Physician Consolidation

On December 18, 2015, the Government Accountability Office (GAO) released a report analyzing the increase in hospital/physician consolidation and a related increase in Medicare hospital outpatient spending. Finding that...more

New Year, New Flexibility: Top 10 Takeaways from CMS Stark Law Final Rule

On November 16, 2015, the Centers for Medicare & Medicaid Services (“CMS”) published the Calendar Year 2016 Physician Fee Schedule final rule with comment period, which includes a final rule (the “Final Rule”) that amends...more

CMS Schedules Call on MACRA Global Surgery Data Requirement (Jan. 20)

On January 20, 2016, CMS is holding a call on data collection requirements related to global surgical periods as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under this provision, the...more

Two New Exceptions to Stark to Become Effective in the New Year

Starting January 1, 2016, physicians and certain health care organizations will be able to take advantage of two new exceptions to the physician self-referral law (commonly referred to as the “Stark Law”). Stark contains two...more

Final Stark Law Regulations Published by CMS

As previously discussed here and on our Health Industry Washington Watch blog here the Centers for Medicare & Medicaid Services (CMS) has released final regulations under the physician self-referral law known as the Stark...more

Summary of 2016 CMS Final Rule for Advance Care Planning

On October 30, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2016 final Medicare payment rules for physicians, hospitals and other providers. The rules include a provision that empowers patients,...more

CMS Finalizes Controversial Changes to "2-Midnight Rule" for Inpatient Stays

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released its final rule updating the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for...more

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