Gabriel Scott at Polsinelli

CMS Makes Changes to MSSP in 2019 Physician Fee Schedule

In the 2019 Medicare Physician Fee Schedule (MPFS) final rule published on November 23, CMS published new policies for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). ...more

12/5/2018 / ACOs , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Shared Savings Program , MPFS , Physician Fee Schedule

CMS “Goes Fishing” on Stark Law’s Impediments to Value-Based, Coordinated Care

On June 20, 2018, the Centers for Medicare & Medicaid Services and Department of Health and Human Services issued a “request for information” (RFI) seeking input on strategies to reduce the burden of the federal physician...more

6/22/2018 / Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Request For Information , Stark Law , Value-Based Care

Continuing Resolution Creates Significant Changes to Medicare and Medicaid Policies

The Bipartisan Budget Act of 2018, commonly referred to as the “Continuing Resolution,” was recently signed into law, creating a short-term fix to funding the federal government for six weeks while also raising the debt...more

3/22/2018 / ACOs , Anti-Kickback Statute , Bipartisan Budget Act , False Claims Act (FCA) , Fraud and Abuse , Health Care Providers , Healthcare Fraud , Medicaid , Medicare , Medicare Access and CHIP Reauthorization (MACRA) , Quality Payment Program (QPP) , Stark Law , Telehealth

Gainsharing Guidance: Clarification on Cost-Savings Arrangements Between Hospitals and Physicians

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) recently posted its first advisory opinion interpreting a gainsharing arrangement – that is, a financial relationship under which...more

1/23/2018 / Anti-Kickback Statute , Gainsharing , Health Care Providers , Hospitals , Medicare Access and CHIP Reauthorization (MACRA) , OIG , Physicians

CMS Terminates and Scales Back Mandatory Bundled Payment Models

The Centers for Medicare & Medicaid Services (CMS) recently published a final rule that cancels the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, each of which were slated to begin...more

12/15/2017 / BPCI , Bundled Payments , Centers for Medicare & Medicaid Services (CMS) , Episode Payment Models (EPM) , Health Care Providers

Newly-Announced 340B Payment Rule Presents Financial & Operational Challenges to All Covered Entities

In its 2018 Outpatient Prospective Payment System final rule (Final Rule) issued Nov. 1, Centers for Medicare and Medicaid Services (CMS) implemented a significant Medicare Part B payment reduction for separately payable,...more

11/6/2017 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Final Rules , Medical Reimbursement , Medicare Part B , Outpatient Prospective Payment System (OPPS) , Prescription Drugs , Section 340B

CMMI Requests Ideas to Spur Innovation and Reduce Burden

The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more

10/9/2017 / ACOs , Alternative Payment Models (APM) , CMMI , Health Care Providers , Medicaid , Medicare , PTAC , Quality Payment Program (QPP) , Regulatory Standards , Request For Information

Hospital Medicare Certification at Risk? CMS Clarifies Inpatient Volume Expectations

Hospitals with dangerously low inpatient volume and micro hospitals focused primarily on the delivery of outpatient and/or emergency room services instead of inpatient services beware: CMS (Centers for Medicare and Medicaid...more

9/25/2017 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Inpatient Billing , Medical Certification Requests , Medicare , Medicare Provider Agreements

Dealing with Disasters – Quality Payment Program Exception Available for MIPS-Participating Clinicians and Groups

The Centers for Medicare & Medicaid Services (CMS) simplified the process for clinicians and other providers to seek the Quality Payment Program (QPP) Hardship exception by releasing an online application on Aug. 2....more

9/22/2017 / CEHRT , Centers for Medicare & Medicaid Services (CMS) , Exclusions , Health Care Providers , Medicare Access and CHIP Reauthorization (MACRA) , MIPS , Physician Fee Schedule , Physician Medicare Reimbursements , Physicians , Quality Payment Program (QPP)

CMS Proposal Terminates and Revises Mandatory Bundled Payment Models

On August 15, 2017, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule which would cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, each of which...more

8/18/2017 / Bundled Payments , CCJR , Centers for Medicare & Medicaid Services (CMS) , Episode Payment Models (EPM) , Hospitals , Provider Payments , Public Comment

Gabriel Scott

Polsinelli

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