News & Analysis as of

Patient Protection and Affordable Care Act (PPACA) › Medicare › Alternative Payment Models (APM)

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
McDermott+

The MIPS Effect: A Surprise Twist in Estimating Medicare Payments for Clinicians Next Year

McDermott+ on

As physician groups and other stakeholders work to finalize comment letters on the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed regulation by September 11, 2023, the Centers for Medicare & Medicaid Services...more

Manatt, Phelps & Phillips, LLP

Manatt on Health: September 2017

Manatt, Phelps & Phillips, LLP on

1332 Waivers Under Review at CMS - The Trump administration has approved one 1332 waiver to date, but four more are pending, including a sweeping Iowa waiver. Here is where things stand today...more

Baker Donelson

Final Rule Implements Quality Payment Program under MACRA

Baker Donelson on

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

Burr & Forman

2016 Health Care Year in Review

Burr & Forman on

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

Mintz - Health Care Viewpoints

Promise to Repeal the ACA Poses Threat to MACRA Implementation

Mintz - Health Care Viewpoints on

Most of the post-election discussion of the ACA has focused on how promises to repeal the law could impact the newly insured. But one priority area of the ACA that has received very little discussion is the federal...more

Locke Lord LLP

The New Era of Health Care Reform

Locke Lord LLP on

Welcome to the inaugural edition of The New Era of Health Care Reform which highlights important developments in health care reform under the Trump Administration. A FIRST LOOK AT HEALTH CARE PRIORITIES OF...more

McDermott Will & Emery

Briefing Points for the Board: The Election and the 2017 Health Policy Agenda

McDermott Will & Emery on

It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and...more

Holland & Knight LLP

CMS Finalizes Sweeping Changes to Medicare Physician Payments

Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Oct. 14, 2016, released the highly anticipated Final Rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP...more

Poyner Spruill LLP

Corridors - October 2016 - News for North Carolina Hospitals

Poyner Spruill LLP on

Proposed 2017 Hospital OPPS Rule Would End Medicare Payments to Many Off-Campus Facilities at the Same Levels as Hospital-Based Outpatient Departments - Published on July 14, 2016, CMS’s proposed 2017 Hospital...more

Morgan Lewis

Senate Finance Committee Examines Repeal of the Stark Law

Morgan Lewis on

A new report suggests that the Stark law is obsolete in new payment models. On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more

Pierce Atwood LLP

APMs, MIPS, and the Final MSSP Rule - The Journey from Volume to Value-Based Reimbursement Continues

Pierce Atwood LLP on

Since the Affordable Care Act was enacted, many providers have been shifting away from traditional fee-for-service, volume-based reimbursement models to payment mechanisms that take a data-driven approach to managing patients...more

Mintz - ML Strategies

Health Care Update - February 2016

Mintz - ML Strategies on

Are Lawmakers and Stakeholders Ready for the Silver Tsunami? - Last week, the Congressional Budget Office (CBO) released a projection that shows Medicare enrollment will grow by more than 30 percent in the next decade...more

Burr & Forman

2015 Health Care Year in Review

Burr & Forman on

In 2015, ICD-10 finally became a reality, and the dire predictions of problems seem to be wrong. Providers now have codes to describe just about every conceivable (and a few simply bizarre) medical occurrences. If a patient...more

Mintz - ML Strategies

Health Care Update - October 2015

Mintz - ML Strategies on

Senate Working Group Pressing Forward on Telehealth - As Congress focuses on bigger picture policy decisions, including broad budget negotiations and raising the debt ceiling, there are some exciting developments on the...more

Mintz - Health Care Viewpoints

Medicare to Permit Value-Based Insurance Design in Medicare Advantage Plans

Mintz - Health Care Viewpoints on

The Centers for Medicare & Medicaid Services (“CMS”) recently announced that, beginning January 1, 2017, Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee will be permitted...more

Mintz - ML Strategies

Health Care Update - August 2015

Mintz - ML Strategies on

CMS Releases Final Payment Rules (IPPS, IRF, LTCHs, Hospice, and Psych): At the end of last week, the Centers for Medicare and Medicaid Services (CMS) released a set of final 2016 payment rules affecting acute care hospitals...more

King & Spalding

CMS Issues FY 2016 IPPS and LTCH Final Rule

King & Spalding on

On July 31, 2015, CMS issued its final rule to update the fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective...more

King & Spalding

CMS Issues CY 2016 Medicare Physician Fee Schedule Proposed Rule

King & Spalding on

On July 8, 2015, CMS issued its annual proposed rule outlining payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) for CY 2016. In the proposed rule,...more

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

Mintz - Health Care Viewpoints on

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Mintz - ML Strategies

Health Care Update - July 2015 #1

Mintz - ML Strategies on

In This Issue: - Recent Mandatory APMs Signal Evolution in Delivery Reform Efforts - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional Initiatives - Upcoming...more

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