Physician Compensation and Reimbursement
The Calendar Year 2026 Physician Fee Schedule Final Rule includes several targeted, but material, changes to the average sales price (ASP) calculation and reporting that directly impact pharmaceutical manufacturers, with...more
The Centers for Medicare & Medicaid Services (CMS) recently announced a new payment initiative that will require certain cardiologists to participate in a value-based reimbursement model focused on heart failure care. This...more
2026 is shaping up to be a pivotal year for health care reimbursement. From major CMS payment rules to evolving disclosure requirements, AI scrutiny, and mounting pressure on providers across the care continuum, the 2026...more
As part of its calendar year 2026 Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (“CMS”) made permanent a major change to its physician direct supervision rules. Effective January 1, 2026, for...more
The final Medicare Physician Fee Schedule for 2026 has now taken effect. Under the new rule, Center for Medicare Services (CMS) finalized two separate Medicare conversion factors depending on participation in a qualifying...more
Drug manufacturers, group purchasing organizations, and other companies in the drug distribution chain will be impacted by the changes to average sales price (ASP) and bona fide service fees (BFSFs) adopted by the Centers for...more
Happy holidays! We are coming to the end of 2025, and what a year in healthcare it was! With a new administration, the Centers for Medicare & Medicaid Services (CMS) and other federal agencies have been extremely busy...more
On Oct. 31, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Physician Fee Schedule Final Rule (Final Rule), which outlines the changes to payments under the Medicare Physician Fee Schedule (PFS) for...more
On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule, which finalized the Ambulatory Specialty Model (ASM), targeting...more
Following a brief Thanksgiving holiday break, U.S. Congress faces just a handful of legislative days before year-end, and the next two weeks promise a crowded calendar as lawmakers race to meet major deadlines....more
On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized the Ambulatory Specialty Model (ASM) in the CY 2026 Medicare Physician Fee Schedule (PFS) final rule. ...more
On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the physician fee schedule (PFS) final rule for calendar year (CY) 2026 (Final Rule). ...more
After issuing the Physician Fee Schedule (PFS) on October 31, the Centers for Medicare & Medicaid Services (CMS) has now published templates for manufacturers to utilize when complying with new requirements regarding the...more
On November 21, 2025, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final...more
The Centers for Medicare & Medicaid Services (“CMS”) recently finalized a rule establishing the new Ambulatory Specialty Model (“ASM”)— a mandatory value-based payment model that could apply to nearly one-quarter of all...more
This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for October 2025, which was relatively quiet due to the federal government shutdown....more
We are still waiting for the Centers for Medicare & Medicaid Services (CMS) to issue the remaining three calendar year (CY) 2026 Medicare payment rules....more
On November 6, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a press release announcing the voluntary “GENErating cost Reductions for U.S. Medicaid (GENEROUS)” payment model, which will implement most...more
On November 5, 2025, CMS issued a final rule implementing changes to the to the Medicare Physician Fee Schedule (PFS), Medicare Shared Savings Program Requirements, and Medicare Prescription Drug Inflation Rebate Program for...more
On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule. The final rule,1 which was published in the Federal Register on...more
On Oct. 31, the Centers for Medicare & Medicaid Services (CMS) released the 2026 Medicare Physician Fee Schedule Final Rule, wherein it established the Ambulatory Specialty Model (ASM) – a mandatory alternative payment model...more
The Centers for Medicare & Medicaid Services (“CMS”) recently finalized a Medicare payment rule with significant implications for life sciences companies, particularly biotech and pharmaceutical manufacturers....more
The final rule for the 2026 Medicare Fee Schedule was released by the Centers for Medicare and Medicaid Services (CMS) on October 31, and it appears to have been finalized almost exactly as it was proposed. ...more
The end of the longest government shutdown in US history is finally here, with the president having signed a continuing resolution (CR) that funds the government through January 30, 2026....more
On October 31, CMS finalized the CY 2026 Medicare Physician Fee Schedule (PFS) rule (CMS-1832-F), effective January 1, 2026. While primarily directed at Medicare providers, the rule’s changes have clear downstream effects for...more