News & Analysis as of

Physicians Centers for Medicare & Medicaid Services

MACRA Update: Attestation Regarding Your EHR System

by Fox Rothschild LLP on

CMS recently issued guidance on the three-part “Prevention of Information Blocking” attestation which physicians and other eligible clinicians will need to submit to CMS in order to qualify for points under the “Advancing...more

CMS Releases Final 2018 Medicare Payment Regulations

by Baker Donelson on

On November 1 and 2, the Centers for Medicare and Medicaid Services (CMS) released the final 2018 Medicare Payment Regulations for the Physician Fee Schedule, Hospital Outpatient Prospective Payment System and Ambulatory...more

Recent Case Highlights Risks of Paying Physicians for Routine Duties - Signed writing required, informal documentation may not be...

by Stinson Leonard Street on

Payments to physicians, even for routine, necessary duties, may cause referrals to the entity making the payments to be "prohibited referrals" under the Stark Law. This means the hospital or other entity should not have...more

CMS Finalizes Medicare Physician Fee Schedule Update for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published its final Medicare physician fee schedule (PFS) rule for CY 2018. In addition to updating rates for 2018, the rule includes important policy changes, including...more

Top Takeaways for Medicare Physician and Hospital Payments in 2018

by Holland & Knight LLP on

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2017, released the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) Payment System Final Rule for...more

The Impact of 2018 Medicare Reimbursement Rates on Providing Dialysis Vascular Access in VAC or OBL Versus ASC Settings

by McGuireWoods LLP on

Earlier this month, the Centers for Medicare and Medicaid Services issued the 2018 Medicare Physician Fee Schedule and Ambulatory Surgical Center Fee Schedule, which included updates to payment policies, payment rates and...more

New Legislation Offers Major Reforms to the Physician Self-Referral Prohibition (the 'Stark Law')

Last week, bipartisan legislation was introduced in the House and Senate to make significant reforms to the Stark Law, which bars a physician from referring patients to an entity with which the physician has a financial...more

Shakespeare on Medical Staff Credentialing

by Faegre Baker Daniels on

Who says a background in English literature has no practical value? Certainly not the attorneys defending Dimensions Health in a class action filed on behalf of patients treated by an OB/GYN on the Dimensions medical staff....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

Will the Massachusetts Proposed Legislation on Hospital Outpatient Facility Fees Have a Nationwide Impact?

by Foley & Lardner LLP on

In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes...more

CMS Clarifies Streamlined Submission to Self-Referral Disclosure Protocol for Physician Organizations

by Baker Ober Health Law on

In an apparent effort to reduce redundancy, CMS issued an FAQ clarifying a simplified process for submissions to the CMS Voluntary Self-Referral Disclosure Protocol (SRDP) involving financial relationships with physicians who...more

CMS Advisory Opinion 2017-01 Approves Pop-up Alerts to Physicians Through Online Laboratory Portal

by Baker Ober Health Law on

A clinical laboratory has received a green light from CMS to offer pop-up notifications alerting physicians of various potential issues (Laboratory Alerts) through its web-based portal for ordering and reporting results of...more

CMS Releases 2018 Open Payments/Sunshine Act Reporting Thresholds

by Reed Smith on

CMS has announced inflation-adjusted de minimis reporting thresholds for 2018 under the Open Payments/Physician Payments Sunshine Act program. Specifically, payments or transfers of value of less than $10.49 do not need to...more

CMS Calls for “New Direction” for Innovation Center, Invites Ideas for New Payment Models

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) CMS has announced a “new direction” for the CMS Innovation Center that is intended to “promote patient-centered care and test market-driven reforms.” The goal of these...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

New CMS Guidance on Inpatient Engagement Necessary for Hospital Certification

by McGuireWoods LLP on

On Sept. 6, 2017, the Centers for Medicare and Medicaid Services (CMS) issued an advanced copy of guidance to state survey agency directors that is intended to clarify how to determine whether a hospital seeking Medicare...more

Final Medicare Payment Regulations Expected for Physician Providers, Hospitals and Home Health Agencies in Fall 2017

by Baker Donelson on

The Centers for Medicare & Medicaid Services (CMS) released several annual Medicare proposed payment rules over the summer that are expected to be finalized this fall for 2018. On July 13, CMS released the proposed 2018...more

Back to School Rules Recap: Hospital and Physician Cheat Sheet on What CMS Did This Summer

by BakerHostetler on

Summer was no vacation for the Centers for Medicare & Medicaid Services (CMS). The agency released a series of significant rules that signal the nature and pace of CMS Medicare payment and policy changes for hospitals and...more

Updates to National Plan and Provider Enumeration System (NPPES) Impact Physicians, Providers, and Suppliers

by Arnall Golden Gregory LLP on

The Centers for Medicare & Medicaid Services (CMS) recently updated the National Plan and Provider Enumeration System (NPPES), which impacts all physicians, providers, and suppliers that use NPPES to obtain or maintain a...more

MACRA Physician Payment Reform: Time to Take Stock of What Is Working and What Changes Are Needed

by Epstein Becker & Green on

In April 2015, Congress established a new framework for Medicare Part B physician payments through the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), which the Centers for Medicare & Medicaid...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

West Virginia Doctor Secures Temporary Restraining Order Against Medicare Exclusion

by Tucker Arensberg, P.C. on

In Robie v. Price, Dr. Robie successfully obtained a temporary restraining order prohibiting CMS from terminating his Medicare billing privileges prior to the exhaustion of his administrative remedies by the U.S. District...more

CMS Proposes QPP Revisions: The Paths for QPP Participation Continue to Evolve

by Baker Ober Health Law on

CMS recently proposed modified policies for continued implementation of the Quality Payment Program (QPP) in the 2017 Proposed Rule. Among other things, the Proposed Rule provides flexibility for clinicians in the second QPP...more

CMS Proposes Medicare Physician Fee Schedule Update for 2018

by Reed Smith on

The Centers for Medicare & Medicaid Services (CMS) has published its proposed rule to update the Medicare physician fee schedule (PFS) for calendar year (CY) 2018. The proposed rule addresses numerous Medicare policies,...more

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