A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration
Counsel That Cares - The Private Payer's Perspective on Value-Based Care
Business Better Podcast Episode: 2024 Advance Notice: Proposed Changes to the Medicare Advantage Risk Adjustment Model
Video: Record-Shattering Year for FCA Recoveries in Health Care - Thought Leaders in Health Law
Hooper, Kearney and Macklin on Cutting Edge Topics in the False Claims Act
Hospice Audit Series: The Latest Developments and Strategies for Success in the Ever-changing Audit Landscape
Podcast: IP(DC): Drug Prices, Political Pressures & Patents
The goal of value-based care (VBC) is to promote better care for individual patients and improved health outcomes for communities at reduced costs. This is an important and admirable purpose as many VBC stakeholders attempt...more
I was struck on the first day of the 41st Annual J.P. Morgan Healthcare Conference by Sanjay Doddamani (CEO of UpStream Healthcare) saying that “Health is a state of independence.” A simple statement, but a very profound and...more
On April 27, 2021, CMS issued the fiscal year (FY) 2022 proposed rule for the hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (the Proposed Rule). Among...more
The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a Letter of Interest (LOI) for a new geographic model option within the Direct Contracting portfolio. The geographic model would transfer full...more
The Centers for Medicare and Medicaid Services (CMS) Direct Contracting Model presents an exciting move towards value-based care with benefits for participants, providers and patients alike. However, the model raises a number...more
The Centers for Medicare and Medicaid Services (CMS) is launching new value-based programs with great fervor as a central strategy to bend the healthcare cost curve. Value-based reimbursement models linked to achieving the...more
In 2018, even more than in recent years, federal lawmakers and regulators continued the push toward modernizing the existing legal framework to support and encourage digital health adoption in the context of care coordination...more
The OIG added eight new items to its Work Plan in the June 2018 update. Among the items addressed are contingency planning for information technology systems, denials and appeals in Medicare Part D, review of certain home...more
The recently enacted Bipartisan Budget Act of 2018 expands Medicare’s coverage for telehealth services in several ways. Inclusion of these provisions, which had been part of a Senate bill called the CHRONIC Care Act, is...more
Following a brief shutdown of the federal government, on February 9, Congress passed and President Donald J. Trump signed into law the Bipartisan Budget Act of 2018 (Budget Act), which provides Congress until March 23 to...more
On February 9, 2018, Congress passed and the President signed into law the Bipartisan Budget Act of 2018 (BBA). This wide-reaching legislation enacts major changes for telehealth policy in Medicare by incorporating policies...more
A New Look at Digital Health Business Models - Editor’s Note: The Commonwealth Fund is developing an innovative digital health advisor (DHA)—an integrated suite of digital services that would provide consumers with health...more
Telehealth continues to be a frontrunner on one strategy to achieve the triple aim, an effort to improve patient experience, population health and reduce per capita cost. To date, government reimbursement for telehealth...more
Last week, the Congressional Budget Office (CBO) concluded that a key piece of telehealth legislation, the CHRONIC Care Act of 2017, would not, overall, increase or decrease Medicare spending. This score is significant as it...more
Collaborative efforts between congressional offices and various health care stakeholders, as well as the feedback provided in response to the Bipartisan CHRONIC Care Working Group Policy Options Document released in December...more
On July 7, 2016, CMS issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017 (Proposed...more
Real-Time Data Analytics in Government Investigations and Reducing Exposure - It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more
In keeping with the boom of telehealth legislation introduced last year at both the state and federal level, the Senate Finance Committee is considering several policy changes that, if ultimately enacted, could make...more
The Senate Finance Committee chronic care working group recently released a Policy Options Document continuing an effort that started with a hearing titled, “Chronic Illness: Addressing Patients’ Unmet Needs” in the summer of...more
On December 18, 2015, the United States Senate Committee on Finance (the Committee) released a Bipartisan Chronic Care Working Group Policy Options Document), which outlines approaches under consideration to improve the care...more
This Week: House E&C 21st Century Cures Bill Passes Unanimously Out of Committee... House Votes to Codify Permanent R&D Tax Credit... CMS Released Proposed Rule Concerning Medicaid and CHIP Plans....more
On June 30, in one of the most highly anticipated cases affecting the Affordable Care Act (ACA), the Supreme Court ruled that closely held companies could assert a “religious objection” to the ACA contraceptive coverage...more
In what is believed to be the first legal challenge to the HIPAA Omnibus Rule (the “Rule”), a vendor of prescription drug adherence services is seeking an injunction to block certain provisions of the Rule related to drug...more