The Medicare Payment Advisory Commission (MedPAC) has issued its annual recommendations to Congress on updates to Medicare fee-for-service payment system rates, many of which overlap recommendations made in previous years. For instance, MedPAC continues to call for implementation of a unified prospective payment system (PPS) for post-acute care (PAC) providers, including skilled nursing facilities (SNFs), … Continue Reading
Rule Would Delay Appropriate Use Criteria Requirement until 2019, Cut Rates for Off-Campus Hospital Departments 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, including: implementation of appropriate use criteria (AUC) … Continue Reading
The Centers for Medicare & Medicaid Services (CMS) has issued its final Medicare physician fee schedule (MPFS) for calendar year (CY) 2017. In addition to updating MPFS rates and policies, the final rule makes numerous other Medicare policy changes, including updates to Stark Law regulations related to unit-based compensation and new enrollment requirements for providers and … Continue Reading
Temporary Transition Policies Reduce Threat of Negative Adjustments in 2019, But Adds to Complexity On November 4, 2016, the Centers for Medicare & Medicaid Services (CMS) is publishing a sweeping final rule reforming the Medicare physician fee schedule (MPFS) update framework, as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Beginning … Continue Reading
The Physician-Focused Payment Model Technical Advisory Committee will meet on September 16, 2016. The Committee will continue discussions about the process by which physician focused payment model proposals will be received and reviewed by the Committee in accordance with regulations implementing Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) physician payment reforms. … Continue Reading
The Centers for Medicare & Medicaid Services (CMS) has published its proposed rule to update the Medicare physician fee schedule (MPFS) for calendar year (CY) 2017. The proposed rule contains numerous Medicare payment and policy proposals, including consideration of potentially misvalued codes, revisions to diagnostic imaging policies, updates to Stark Law regulations, and new enrollment … Continue Reading
Congressional committees held hearings on a wide variety of on health policy issues this month before going on summer recess. Notable hearings include the following:… Continue Reading
The Centers for Medicare & Medicaid Services (CMS) has proposed regulations to implement major reforms of the Medicare physician fee schedule (MPFS) update framework that were mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As discussed in our client alert, MACRA repealed the longstanding sustainable growth rate (SGR) methodology for updating … Continue Reading
A number of recent Congressional hearings have focused on health policy topics, including the following: A House Energy and Commerce Subcommittee on Health hearing on “Medicare Access and CHIP Reauthorization Act of 2015: Examining Physician Efforts to Prepare for Medicare Payment Reforms.” A House Judiciary Constitution and Civil Justice Subcommittee hearing on oversight of the False … Continue Reading
On April 19, 2016, the House Energy and Commerce Subcommittee on Health is holding a hearing entitled “Medicare Access and CHIP Reauthorization Act of 2015: Examining Physician Efforts to Prepare for Medicare Payment Reforms.” The hearing will focus on major physician organizations’ investments in the development of alternative payment models, quality measures, and practice improvements.… Continue Reading
The White House Office of Management and Budget (OMB) is now reviewing a highly-anticipated Centers for Medicare & Medicaid Services’ (CMS) proposed rule to implement major Medicare physician payment reform provisions included in the Medicare Access and CHIP Reauthorization Act (MACRA). As previously reported, MACRA repealed the Medicare sustainable growth rate (SGR) formula and directed … Continue Reading
Congressional committees have held hearings recently on various health policy issues, including: Energy and Commerce Committee hearings on CMS implementation of the Medicare physician fee schedule reform provisions included in the Medicare Access and CHIP Reauthorization Act (MACRA), financing and delivery of long-term care, and the public health response to the Zika virus. A Ways … Continue Reading
CMS has posted corrections to the 2016 Medicare physician fee schedule payment files. Among other things, CMS has revised the conversion factor, reducing it slightly from $35.8279 to $35.8043. CMS has also made changes to relative value unit values for various procedure codes.… Continue Reading
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) includes payment incentives to encourage providers to participate in alternative payment models (APMs) that focus on coordinating care, improving quality, and reducing costs. MACRA established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to provide recommendations to the Secretary of Health and Human Services on … Continue Reading
On January 20, 2016, CMS is holding a call on data collection requirements related to global surgical periods as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under this provision, the Secretary is directed to periodically collect information from a representative sample of physicians regarding the number and level of services and … Continue Reading
CMS has extended the comment period on its October 1, 2015 request for information (RFI) regarding implementation of the Merit-based Incentive Payment System and promotion of alternative payment models in accordance with MACRA. The comment period, which originally was scheduled to end on November 2, 2015, has been extended until November 17, 2015. CMS also … Continue Reading
On October 1, 2015, CMS published a request for information (RFI) regarding implementation of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provisions that mandate significant reforms of the Medicare physician payment system. As previously reported, MACRA repealed the sustainable growth rate methodology (SGR) for updating the Medicare physician fee schedule, and after a … Continue Reading
On July 15, 2015, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare physician fee schedule (MPFS) for CY 2016 – the first rulemaking since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the sustainable growth rate (SGR) formula. Under the proposed rule, the 2016 … Continue Reading
The Government Accountability Office (GAO) has issued a report pointing out potential shortcomings in the data and process used by CMS to establish the relative values (and consequently the reimbursement levels) for Medicare physician services. In particular, the GAO expresses concern that the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) process for … Continue Reading
Today President Obama signed into law H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.… Continue Reading
On February 2, 2015, the Obama Administration released its proposed federal budget for fiscal year (FY) 2016. The budget would impact all types of health care providers, health plans, and drug manufacturers if adopted as proposed – which is unlikely given Republican control of the House and Senate. Nevertheless, Congress can be expected to consider … Continue Reading
The House Energy and Commerce Subcommittee on Health has scheduled a two-day hearing for January 21 and 22 to discuss how to pass Sustainable Growth Rate (SGR) reform legislation before the current patch expires at the end of March 2015.… Continue Reading
In December 2014, President Obama signed into a law H.R. 5771, a tax extender bill that includes the “Achieving a Better Life Experience (ABLE) Act of 2014.” As discussed in a previous post, the law, P.L. 113-295, includes three Medicare provisions to finance the ABLE Act: revisions to payment adjustments for Medicare physician fee schedule misvalued … Continue Reading
CMS has posted a January 2015 release of the National Physician Fee Schedule Relative Value File, reflecting a conversion factor (CF) of $35.7547 – down slightly from the $35.8013 included in the 2015 final MPFS rule published on November 12, 2014. CMS is expected to publish a notice explaining the reasons for the revised CF. … Continue Reading
