News & Analysis as of

Fee-for-Service

Who Pays? The Promise of Telehealth, Part II in a Series Addressing the Role of Telehealth in the Delivery of Health Care in New...

by Hodgson Russ LLP on

Advances in telecommunications, including improvements in high resolution imaging and access to broadband, are accelerating the availability of telehealth. Still, an important question remains: who pays for telehealth...more

A District Attorney May Employ Outside Counsel on a Contingent Fee Basis - Ninth Circuit Opinion in Unfair Competition Suit...

by Best Best & Krieger LLP on

The District Attorney of Trinity County filed a civil action under California’s Unfair Competition Law, alleging deceptive marketing and sales practices. The action sought an injunction, restitution, attorney fees and civil...more

CMS Proposes Easing Rules for State Medicaid FFS Access Monitoring

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) is proposing to exempt states with high rates of Medicaid managed care enrollment from current requirements to analyze and monitor access in fee-for-service (FFS) delivery...more

OIG February 2018 Work Plan Update

by Baker Ober Health Law on

The OIG added three items to its Work Plan with the February 2018 update, as listed in the chart below. Two of the items concern annual reports, one addressing the performance of Medicaid Fraud Control Units and the other...more

CMS's New Advanced APM: Bundled Payments for Care Improvement Advanced

by Ropes & Gray LLP on

On January 9, 2018, the Centers for Medicare & Medicaid Services (“CMS”) Center for Medicare and Medicaid Innovation (“CMMI”) announced a new voluntary bundled payment model called “Bundled Payments for Care Improvement...more

CMS Gives States Options for Complying with Cures Act Mandate to Cap Medicaid DME Rates

by Reed Smith on

As previously reported, the 21st Century Cures Act prohibits federal financial participation (FFP) payments to the states for certain Medicaid durable medical equipment (DME) expenditures that exceed what Medicare would have...more

CMS announces new voluntary episode-payment program: BPCI Advanced

by Thompson Coburn LLP on

On Jan. 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary episode-payment program, Bundled Payments for Care Improvement Advanced (BPCI Advanced). Following on the success of the initial...more

Value-based health care: compliance infrastructure

by Ropes & Gray LLP on

Brett Friedman, Ropes & Gray health care partner, discusses the impact to compliance organizations as payment models transition from traditional fee-for-service to value-based. ------- As the payment models have shifted...more

New Audits and Penalties on Medicaid Plans and Providers Related to Encounter Data in Value-Based Payment Models

by Epstein Becker & Green on

For value-based payments, encounter data[1] provides valuable information in much the same way that claims data does for fee-for-service arrangements. With the growing prevalence of value-based payments, especially in the...more

President Orders FTC to Report on Competition in Healthcare Markets

by Perkins Coie on

On October 12, 2017, President Donald J. Trump signed an executive order designed to promote choice and competition in healthcare markets. The order was reported as a first step in the administration’s effort to undermine the...more

Focus on Health Care Provider Bankruptcies

by Jones Day on

The next few years are expected to see a significant increase in the volume of bankruptcy cases filed by health care providers. Thus far in 2017, the number of bankruptcies in health care-related sectors, including hospitals,...more

Impact of Value-Based Health Care on the Medical Device Industry: Three Takeaways From the Case for Transformation

by Ropes & Gray LLP on

Introduction: The Case for Transformation - In the world of fee-for-service health care, most medical devices were sold to hospitals or other health care providers for use in the diagnosis or treatment of patients. Except...more

Patient Safety Issues Highlighted in DOJ Settlement and Health Care Industry Cybersecurity Task Force Report

by Pierce Atwood LLP on

As we know, the move away from fee for service reimbursement models is not only intended to reduce costs by no longer paying providers based on the volume of services performed, but is also intended to improve the overall...more

Brave New World: Compliance and the Transition to Value-Based Care

by Ropes & Gray LLP on

The U.S. health care system is in the midst of a fundamental shift, away from traditional “fee-for-service” models that reward providers for the quantity of services provided to patients, toward value-based models designed to...more

Recommendations for Medical Device Manufacturers

by Ropes & Gray LLP on

The U.S. health care system is in the midst of a fundamental shift, away from traditional fee-for-service models that reward providers based upon the volume of services provided to patients, and toward value-based care...more

Manatt on Medicaid: Maine Releases Draft Waiver Request Proposing New Eligibility Requirements

On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more

CMS Delays Effective Date for Episode Payment Model (EPM) Final Rule

by King & Spalding on

CMS has announced that the effective date for the Final Rule for certain EPMs will be delayed until May 20, 2017. This is the second delay for the Final Rule. CMS previously pushed the effective date from February 18 to March...more

CMS makes economics of primary care ACOs more appealing: Smith Anderson

by Smith Anderson on

As you may have read, accountable care organizations have met uneven success over the last several years. But, when they are broken down into categories, physician-sponsored ACOs have done better, particularly those with a...more

Also In The News - Health Headlines - November 2016

by King & Spalding on

CMS Names Latest Round of RAC Contracts – On October 31, 2016, CMS announced it awarded contracts for its Medicare Fee-for-Service Recovery Audit Contractors (RAC) to Performant Recovery, Inc. (Region 1), Cotiviti, LLC...more

The New Era of Health Care Reform

by 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

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

by 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

Making Sense of the MACRA Final Rule, Part 1 of 3: Essential Concepts

by Polsinelli on

On Oct. 14, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The nearly 2,400 pages of...more

MACRA: Top 10 FAQs

by Carlton Fields on

Significant changes to the Medicare payment system are underway. The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is set to take effect January 1, 2017. MACRA represents a deliberate departure by the...more

Managing the Transition to Transformation: Quality and Payment Reform: Who Is Asking for What and Why?

by McDermott Will & Emery on

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

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