Affordable Care Act, Physicians, Centers for Medicare & Medicaid Services (CMS)

CMS Proposes Significant Changes to the Medicare Shared Savings Program and 60-Day Rule

Baker Donelson on 8/9/2024

Under the CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposes several modifications to the Medicare Shared Savings Program (MSSP) that would become effective in performance year 2025. CMS also proposed...more

Findings from Gibbins’ Annual Healthcare Bankruptcy Report

Holland & Knight LLP on 4/8/2024

In this episode of "Counsel That Cares," bankruptcy attorney Tyler Layne is joined by Gibbins Advisors managing directors Clare Moylan and Ron Winters to discuss their company's annual healthcare bankruptcy report. Their...more

The MIPS Effect: A Surprise Twist in Estimating Medicare Payments for Clinicians Next Year

McDermott+ on 8/24/2023

As physician groups and other stakeholders work to finalize comment letters on the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed regulation by September 11, 2023, the Centers for Medicare & Medicaid Services...more

Credible Information Is Heart of 60-Day Rule; OIG: Self-Disclosure Pauses the Clock

Health Care Compliance Association (HCCA) on 8/4/2021

Report on Medicare Compliance 30, no. 28 (August 2, 2021) - When a hospital realized it had been billing for annual wellness visits without documentation of opioid and substance use screening, it wasn’t a heavy lift to...more

Client Alert: Centers for Medicare and Medicaid Services Hospital Price Transparency Rule

Shumaker, Loop & Kendrick, LLP on 2/12/2021

As of January 1, 2021, almost all hospitals in the United States will have to comply with the Centers for Medicare and Medicaid Services (CMS) Hospital Price Transparency Rule. Additionally, the government has been open about...more

Client Alert: Centers for Medicare and Medicaid Services Introduces Dialysis and Oncology Payment Models

Shumaker, Loop & Kendrick, LLP on 11/23/2020

On September 18, 2020 the Centers for Medicare and Medicaid Services (“CMS”) finalized two new payment models with the aim to reduce Medicare expenditures while improving the quality of care for Medicare beneficiaries....more

New Health Care Transparency Requirements: Will They Lower Cost and Improve Quality?

Epstein Becker & Green on 11/20/2020

On November 12, 2020, the Trump administration published its final rule on price transparency (the “Final Rule”) requiring affected entities to publicly release personalized information on out-of-pocket costs as well as...more

The health insurance mess: Worker costs jump anew, as kids’ coverage falls

Patrick Malone & Associates P.C. | DC Injury... on 10/16/2020

The Covid-19 pandemic has forced many Americans to reconsider their transportation options, what with fears of infection and the slashing of public transit systems’ routes and schedules. That has made used cars, motorcycles,...more

CMS Releases Tools to Support States’ Medicaid and CHIP Programs During the COVID-19 Outbreak

King & Spalding on 4/1/2020

On March 22, 2020, CMS announced a suite of four new tools intended to help states combat the coronavirus by allowing states to streamline enrollment into long-term care and home-based services and by expediting application...more

Healthcare Law Update: October 2019

Holland & Knight LLP on 10/15/2019

In recent years, the healthcare industry has been turning greater attention to the need to engage or involve patients in developing new technologies and systems to improve healthcare delivery. These patient engagement...more

Sunshine Act Expands to Advance Practice Nurses and Physician Assistants

Mintz - Health Care Viewpoints on 10/11/2018

Drug and device manufacturers will need to update their reporting systems and provide new training to their sales staff in the coming years based on changes to the Physician Payment Sunshine Act included in the final opioid...more

Answers to Your Most Biting Questions About Service and Comfort Animals

Baker Donelson on 9/4/2018

It is becoming more common to see people accompanied by an animal at a variety of locations – grocery stores, malls, big box stores, post offices, etc. But what happens when a patient or employee arrives at your health care...more

If You're Reading This, You're Too Late: Key Drivers in Rising Health Care Defaults

Baker Donelson on 7/30/2018

Health care bankruptcy filings more than tripled in 2017 as compared to 2016 with no end in sight to the financial struggles facing owners and operators in the sector. According to Bloomberg, health care bankruptcies have...more

Driving Health Care Efficiencies: Consolidate and Innovate, But Proceed with Caution

Brownstein Hyatt Farber Schreck on 3/20/2018

Despite the U.S. substantially outspending peer high-income nations with almost 18 percent of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, the...more

Healthcare Fraud & Abuse Review 2017

Bass, Berry & Sims PLC on 3/13/2018

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Lifting the Limits on Physician-Owned Hospitals: Can Regulators Prevail Where Legislators Have Stalled?

Sheppard Mullin Richter & Hampton LLP on 3/5/2018

We reported, in early 2017, on what was then the latest legislative effort to repeal the Affordable Care Act’s amendment to the Stark Law’s whole hospital exception, which amendment has effectively prevented new...more

2017 Healthcare Year in Review

Burr & Forman on 12/18/2017

If the 2017 healthcare environment could be summed up in one word, it would be “uncertainty.” With the largely unexpected election of Donald Trump as President, the multiple, unsuccessful attempts by the Republican controlled...more

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

Foley & Lardner LLP on 11/1/2017

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

Baker Donelson on 8/5/2017

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 Open Payments: A Look Behind the Curtain

McGuireWoods LLP on 7/6/2017

Compliance officers often lament that it is impossible to identify, assess and manage the compliance risks of financial relationships they know nothing about. Too often they are limited to relationships brought to their...more

Disputing Inaccurate Reports Under the Physician Payment Sunshine Act

Ruder Ware on 4/7/2017

The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical...more

When is a Physician Liable for Stark Law Violations?

Ruder Ware on 3/30/2017

I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians. This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group....more

Health Law Insights: January Newsletter

Roetzel & Andress on 1/27/2017

ALERT: Health Reform Outlook for 2017: A Year of Major Uncertainty - Fulfilling their promises, Congressional Republicans moved to repeal the Affordable Care Act (ACA) on the first day of the new Congress when Senate...more

Final Rule Implements Quality Payment Program under MACRA

Baker Donelson on 12/30/2016

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more

2016 Health Care Year in Review

Burr & Forman on 12/12/2016

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

Patient Protection and Affordable Care Act (PPACA) › Physicians › Centers for Medicare & Medicaid Services (CMS)

"My best business intelligence, in one easy email…"