News & Analysis as of

Physician Medicare Reimbursements Centers for Medicare & Medicaid Services

What's Next Now that Mandatory EPM and Cardiac Rehabilitation Payment Models Have Been Terminated?

by Baker Ober Health Law on

CMS released its Final Rule canceling the Episode Payment Model (EPM) and Cardiac Rehabilitation Incentive Payment Model (CR Incentive Payment Model). This was an expected result following August's proposed rule to cancel...more

Legislation, Lawsuit Cloud Future of 340B Program Payment Rate Reductions

by Jones Day on

The Situation: A Final Rule published by the Centers for Medicare & Medicaid Services carries a provision that reduces reimbursement for most 340B Program drugs dispensed by disproportionate share hospitals and rural referral...more

“We’re Listening” – CMS Issues Final Rule For Year 2 Of The Quality Payment Program And Highlights Efforts To Continue...

by Pierce Atwood LLP on

On November 2, 2017, CMS issued the final rule with comment for the second year (2018) of the Quality Payment Program as well as an interim final rule. Continuing with its theme of a CMS that is “listening to feedback,” CMS...more

Year 2 in the QPP: A Regulatory Update

by Polsinelli on

On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Quality Payment Program (QPP) Final Rule. The Final Rule contains notable changes that may affect smaller practices participating in...more

Final Home Health Rule Drops Controversial Proposed Payment Model

by Bass, Berry & Sims PLC on

Last week, home health agencies welcomed the Centers for Medicare & Medicaid Services' (CMS) decision to drop a controversial proposed payment model and leave largely unchanged the current payment system. Responding to...more

CMS Finalizes Reimbursement Cuts for 340B Hospitals

by Foley & Lardner LLP on

In a striking blow to 340B hospitals, the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) released a final Medicare Outpatient Prospective Payment System (OPPS) rule adopting its...more

Health Care Newsmakers: Steve McCoy, Vice President/General Counsel, Patient First

by Williams Mullen on

With all the discussion lately about trying to manage the cost of healthcare, what are the most important recent changes in reimbursement methodology and strategies which Patient First has seen in the market? The ongoing...more

340B Update: CMS Finalizes 340B Program Reimbursement Cut on Part B Drugs

by K&L Gates LLP on

On November 1, 2017, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule updating the Medicare hospital Outpatient Prospective Payment System (“OPPS”) for the calendar year 2018. As part of this update,...more

CMS Addresses Lingering Uncertainties and Raises Others via MACRA Information Blocking Guidance

The Centers for Medicare & Medicaid Services (CMS) recently issued guidance intended to help clinicians eligible for the Merit-based Incentive Payment System (MIPS) navigate an attestation required thereunder concerning the...more

CMS Finalizes Medicare Part B Reimbursement Cut for 340B – What Does it Mean?

On November 1, 2017, CMS announced that it is in fact cutting Medicare Part B reimbursement for 340B drugs to the tune of $1.6 billion. To be accurate, what CMS announced is its intent to finalize proposed rule changes to the...more

Business Viewpoint with Philip Hixon: New rules and costs for long-term care

by GableGotwals on

Ronald Reagan once declared, “The nine most terrifying words in the English language are: ‘I’m from the government, and I’m here to help.’” Long-term care facilities experience this “help” with increasing frequency....more

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

by Polsinelli on

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

Revoked: CMS's New Take on Record Retention and Access

Recently, we have noticed an alarming increase within the Spilman footprint of revocations by the Centers for Medicare & Medicaid Services ("CMS") of physicians' Medicare billing privileges. In particular, CMS has been...more

SuperVision - Labor & Employment Law Insights - September 2017

...This issue of SuperVision is dedicated to questions our friends and clients may have regarding insurance and benefit topics. While not a common part of the Labor & Employment field, Spilman prides itself on having...more

MACRA Update: How to Prepare for Changes in MIPS

As we reported last month, CMS’ proposed rule updating MACRA’s Quality Payment Program (“QPP”) for CY 2018 would extend and expand exceptions that would allow many practitioners to avoid participating in its Merit-based...more

MACRA: Proposed Changes to the Merit-Based Incentive Payment System Track

by Polsinelli on

The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on the Medicare Quality Payment Program (QPP) in the Federal Register1 on June 30, 2017. This rule proposes the QPP program requirements for...more

Sixth Circuit: Technical Physician Signature Deficiencies not "Material" to Reimbursement Claims

by Jones Day on

The District Court for the Middle District of Tennessee held on June 22, 2017, that the timing requirements related to a physician's certification of need for home health services were not "material" to the Centers for...more

MACRA Quality Payment Program Update

On June 20, 2017, CMS released its proposed rule updating MACRA’s Quality Payment Program (“QPP”) for CY 2018. At over 1,000 pages, the rule might not do much to simplify the already complex requirements of the QPP; however,...more

CMS Extends Comment Period for New SNF PPS Methodology Proposal

by Baker Ober Health Law on

On May 4, for the first time in nearly 15 years, CMS issued an Advanced Notice of Proposed Rulemaking (ANPRM) proposing a total overhaul of the current reimbursement methodology for skilled nursing facilities (SNFs). The...more

CMS Proposes Reimbursement Reduction for 340B Drugs

by Baker Ober Health Law on

When CMS issued its proposed rule for OPPS and ASC Payment System on July 13, the agency included a proposal to substantially scale back reimbursement for Part B drugs to hospitals participating in the federal 340B Drug...more

Six Questions and Answers About CMS’ Recommended Changes to 340B Medicare Reimbursement

In March, I posted about the Uncertain Future of the 340B Drug Discount Program.  When opining about What Could Happen Next I speculated about possible changes to government reimbursement for 340B drugs “so that government...more

Are you subject to MIPS reporting requirements in 2017?

by Thompson Coburn LLP on

The Centers for Medicare and Medicaid Services (“CMS”) announced in late April that they anticipated notifying eligible clinicians about their Merit-based Incentive Payment System (“MIPS”) participation status for 2017 via...more

Government Leaks Lead to Landmark Insider Trading Case

On May 24, 2017, the SEC for the first time brought charges based on allegations of insider trading on confidential government information. The alleged insider trading scheme involved tips related to three announcements by...more

CMS Proposes to Eliminate Therapy-Driven SNF Reimbursement

by Baker Ober Health Law on

It should come as no surprise to anyone working with skilled nursing facilities (SNFs) that CMS has been exploring ways to adjust its current payment model to reduce or eliminate skilled therapy utilization as the primary...more

The Financial Impact of MACRA – Uncertainty Reigns in a Recent Rand Corporation Study

With all the talk of the Affordable Care Act’s uncertain future, it is easy to forget about the Medicare Access and CHIP Reauthorization Act (“MACRA”), a bipartisan law passed by Congress in 2015 to change the way physicians...more

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