News & Analysis as of

Provider Payments

New “Site Neutrality” Proposed Rule Would Slash Hospital Outpatient Payments for Off-Campus Services by 50%

by Seyfarth Shaw LLP on

In a proposed rule published in the Federal Register on July 21, 2017, the Centers for Medicare & Medicaid Services (“CMS”) moved to cut payments for most services provided by off-campus locations of hospitals by 50 percent. ...more

Is Telemedicine Change Coming to Congress? The Medicare Telehealth Parity Act of 2017 Among Several New Federal Bills

by Foley & Lardner LLP on

Congress is reconsidering a nationwide telehealth coverage bill, named the Medicare Telehealth Parity Act of 2017, designed to introduce an incremental, though significant, expansion of coverage for telehealth services under...more

"Locum Tenens" Physical Therapist – Does the Change Provide Sufficient Relief?

by Baker Ober Health Law on

CMS recently published guidance to implement Section 16006 of the 21st Century Cures Act, effective June 13, 2017, which allows physical therapists providing services to Medicare beneficiaries to utilize "locum tenens"...more

CMS Releases the Final Medicare Part D DIR Reporting Requirements for 2016

On Friday, June 23, 2017, CMS released the Final Medicare Part D DIR Reporting Requirements for 2016. Part D sponsors may begin submitting their DIR information on June 30, 2017 and must finish their submissions by the end of...more

CMS Releases MACRA Proposed Rule for 2018

by Baker Ober Health Law on

On June 20, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled, "Medicare Program; CY 2018 Updates to the Quality Payment Program." CMS proposes changes for the second year (2018) of the...more

Are you subject to MIPS reporting requirements in 2017?

by Thompson Coburn LLP on

The Centers for Medicare and Medicaid Services (“CMS”) announced in late April that they anticipated notifying eligible clinicians about their Merit-based Incentive Payment System (“MIPS”) participation status for 2017 via...more

CMS finalizes additional delay for episodic payment programs

by Thompson Coburn LLP on

After earlier delays following the change in administration and leadership, the Centers for Medicare and Medicaid Services (CMS) has set the start date for cardiac episode payment models (EPMs) and revisions to the...more

Anchors Away! Physical Therapists Rejoice (and Book a Tropical Getaway) as CMS Extends Locum Tenens Arrangements

Even doctors get sick sometimes, or need to take a vacation, and when they do, patients are not seen and billing does not happen. Cue locum tenens – a system used by providers to ensure continuity of care and revenue when...more

CMS Releases the Proposed Part D DIR Reporting Requirements for 2016

Yesterday, CMS released the Proposed Part D DIR (Direct and Indirect Remuneration) Reporting Requirements for 2016 and postponed the 2016 DIR Reporting deadline....more

CMS Proposes to Eliminate Therapy-Driven SNF Reimbursement

by Baker Ober Health Law on

It should come as no surprise to anyone working with skilled nursing facilities (SNFs) that CMS has been exploring ways to adjust its current payment model to reduce or eliminate skilled therapy utilization as the primary...more

Proving Utility, Demonstrating Value: How to Align the Moving Parts in Personalized Medicine Reimbursement

by Foley & Lardner LLP on

Of the many business, operational, legal, regulatory and clinical obstacles standing in the way of widespread delivery of personalized medicine, the single greatest challenge may lie in solving the reimbursement puzzle....more

Delayed ETA for EPMs – CMS Delays New Bundled Payment Models

by Baker Ober Health Law on

On March 21, 2017, CMS issued the anticipated delay related to the new Episode Payment Model (EPM) bundled payment program regulations that were finalized in January. The rule, Advancing Care Coordination Through Episode...more

Percentage-Based Billing Contracts Violate Medicaid Regulations and May Constitute Improper Fee-Splitting

by Farrell Fritz, P.C. on

The Medicaid Fraud Control Unit (MCFU) of the New York State Office of the Attorney General has recently issued restitution demand letters to providers for allegedly entering into percentage-based contracts with their billing...more

New York Medical Society Warns Providers to Avoid Percentage-Based Billing

A series of recoupment letters from the New York State Medicaid Fraud Control Unit (MFCU) to healthcare providers who have management or billing company arrangements based on a percentage of collections has prompted the...more

Payor/Provider Convergence: Joint Venture Health Plans

by Foley & Lardner LLP on

Health Plans and health care providers are getting into each other’s business. This payor/provider convergence has taken different forms. Health systems have ventured into the health insurance business by acquiring or...more

Provider Payments Under a Medicaid Per Capita Cap

In a February 24th blog post, we described Medicaid block grants and per capita caps in terms of A x B = C to demonstrate how those payment policies work. ‘A’ is the amount a state is paid per beneficiary, ‘B’ is the number...more

White House “Regulatory Freeze” Delays Implementation of Bundled Payment Models

by King & Spalding on

In the February 17, 2017 Federal Register, CMS announced that it will delay implementation of several bundled payment initiatives until March 21, 2017. The Advancing Care Coordination Through Episode Payment Models (EPMs),...more

Recent Changes to Medicare “Incident To” Billing Rules

by Ruder Ware on

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more

Medicare Mandatory Bundled Payments Rule: Minor Aspects Delayed, Others On-Schedule for July Implementation

by Polsinelli on

In a move the Centers for Medicare & Medicaid Services cites as a reaction to President Donald Trump's regulatory freeze, CMS announced that implementation of certain minor aspects of the final rule expanding Medicare...more

New Bundled Payments Are a Go…For Now

by Baker Ober Health Law on

CMS issued a final rule on January 3, 2017, implementing three new episode payment models (EPMs) and a Cardiac Rehabilitation (CR) incentive payment model under the authority of the Center for Medicare & Medicaid Innovation...more

Big Changes and Uncertainty Looming for Off-Campus Provider-Based Departments

by Alston & Bird on

Originally posted in Bloomberg BNA’s Medicare Report, 28 MCR 96, 2/3/17. On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System (HOPPS) - Final...more

Governor Kasich Releases $144 Billion State Budget Proposal - What You Need to Know

by Roetzel & Andress on

Yesterday, Governor Kasich released the executive version of the state’s two-year operating budget (Fiscal Years 2018-2019), which includes proposed spending of over $144 billion during the biennium. Similar to his previous...more

The Brave New World of Physician Medicare Payment: MACRA Makes Sweeping Changes

by Seyfarth Shaw LLP on

On November 14, 2016, CMS published its final rule implementing the physician payment provisions of the Medicare Access and CHIP Reauthorization Act (“MACRA”). The rule became effective January 1, 2017. Data collection from...more

CMS Finalizes Tighter Rules for New Medicaid Managed Care Pass-Through Payments

by Reed Smith on

CMS has finalized without change its proposed rule to block states from adopting or increasing Medicaid managed care “pass-through” payments to hospitals, nursing facilities, and physicians beyond those in place when...more

Healthcare Transactions: Year in Review - January 2017

by Bass, Berry & Sims PLC on

Healthcare transactional activity continued unabated throughout 2016, continuing a years long trend of sustained growth. This activity is due to a number of factors: innovative technology, pharmaceuticals, and services that...more

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