In recent years, the Centers for Medicare and Medicaid Services (CMS) has expanded coverage for remote patient monitoring (RPM) services under Medicare. RPM services include establishing, implementing, revising, and...more
12/20/2019
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Data Management ,
Data Privacy ,
Digital Health ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Licensing Rules ,
Medical Monitoring ,
Telehealth ,
Telemedicine
Through two separate notices of proposed rule-making (NPRMs), the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG), seek to remove...more
11/13/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Fee-for-Service ,
Health Care Providers ,
Healthcare Fraud ,
Healthcare Reform ,
NPRM ,
OIG ,
Proposed Rules ,
Risk-Based Approaches ,
Rulemaking Process ,
Safe Harbors ,
Stark Law ,
Value-Based Care
We are on the clock. As an industry, we have 75 days to comment on the rules published in the Federal Register this week about how the Stark Law is implemented....more
On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released the FY 2020 Medicare Physician Fee Schedule (MPFS) proposed rule [CMS-1715-P] (Proposed Rule). A link to the full rule is available here....more
Among the new models are “supergroups,” involving combinations of physicians, dentists, vision-care specialists or other individually licensed health care providers to participate in the current and future health care...more
On April 22, 2019, the Centers for Medicare and Medicaid Services (“CMS”) announced four new voluntary payment models that could allow primary care practitioners like physicians or advanced practice nurses, hospitals or other...more
The December 21, 2018 “Pathways to Success” final rule governing Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP) will require expedited migration to financial risk arrangements. The...more
In the 2019 Medicare Physician Fee Schedule (MPFS) final rule published on November 23, CMS published new policies for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). ...more
On June 20, 2018, the Centers for Medicare & Medicaid Services and Department of Health and Human Services issued a “request for information” (RFI) seeking input on strategies to reduce the burden of the federal physician...more
The Centers for Medicare & Medicaid Services (CMS) recently published a final rule that cancels the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, each of which were slated to begin...more
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
The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more
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
On August 15, 2017, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule which would cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, each of which...more
The Centers for Medicare & Medicaid Services (CMS) recently released its final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among its numerous changes,...more
11/9/2016
/ Alternative Payment Models (APM) ,
CEHRT ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Healthcare ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
Physician Medicare Reimbursements ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR)
Many observers view the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a game changer for the delivery and payment of health care services.
On Oct. 14, 2016 the Centers for Medicare & Medicaid Services...more
11/2/2016
/ ACOs ,
Alternative Payment Models (APM) ,
CEHRT ,
Centers for Medicare & Medicaid Services (CMS) ,
Electronic Health Record Incentives ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
Physician Medicare Reimbursements ,
Physicians ,
PQRS ,
Quality Payment Program (QPP)
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
11/1/2016
/ ACOs ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Electronic Health Record Incentives ,
Fee-for-Service ,
Final Rules ,
Health Care Providers ,
Healthcare ,
Meaningful Use ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
Medicare Shared Savings Program ,
MIPS ,
Physician Medicare Reimbursements ,
Physicians ,
PQRS ,
Quality Payment Program (QPP) ,
Sustainable Growth Rate (SGR)
On May 9, 2016, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking to implement the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Although the...more
On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) posted a pre-publication version of a proposed rule implementing changes to Medicare payment for physician services authorized under the bipartisan...more
5/2/2016
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Electronic Health Record Incentives ,
Fee-for-Service ,
Health Care Providers ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
Physicians ,
PQRS
The Department of Justice announced on October 16, 2015 a settlement agreement with Tuomey Healthcare System that resolves a $237 million judgment against the system involving claims submitted to the Medicare program in...more
On September 28, 2015, the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) seeking stakeholder comments related to innovative physician payment models required by the Medicare Access...more
10/1/2015
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
EHR ,
Electronic Health Record Incentives ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
Physician Payments ,
Physicians ,
PQRS ,
Request For Information ,
Value-Based Payments
The $69.5 million settlement by North Broward Hospital District in Fort Lauderdale, Florida to resolve False Claims Act allegations paints a cautionary tale of the importance of hospital practices and optics in connection...more
9/21/2015
/ Compliance ,
Fair Market Value ,
False Claims Act (FCA) ,
Healthcare ,
Hospitals ,
Physicians ,
Settlement ,
Stark Law ,
Unfair Competition ,
Wage and Hour ,
Whistleblowers
In This Issue:
- ACO Eligibility Requirements
- Establishing and Maintaining the ACO Participation Agreement
- Data Sharing and Assignment of Beneficiaries
- Shared Savings and Losses
- Waivers of...more
7/7/2015
/ ACO Participant Agreements ,
ACOs ,
Centers for Medicare & Medicaid Services (CMS) ,
Data-Sharing ,
Electronic Health Record Incentives ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Shared Savings Program ,
Skilled Nursing Facility ,
SNF
In This Issue:
- Top News
..CMS Releases Payment Rules for the Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System, Renal Dialysis and Home Health
..President Signs the Drug Quality...more
In This Issue:
- Norman PHO
- Key Conclusions
- Implications for Established and Newly Forming Networks
- Excerpt from Norman PHO:
The Norman PHO is comprised of a single hospital system and...more