Labeling Medicare a “rigged system,” President Trump has outlined a plan that he believes would allow it to lower drug prices covered under its Part B coverage. Specifically, the proposal would permit Medicare to implement a new reimbursement scheme that would reduce drug prices to achieve parity with costs in other nations.» Read More

Space sharing and co-location arrangements have been popular service delivery models for hospitals and independent physician practices.  These arrangements enhance patient convenience, improve continuity of care and present cost sharing benefits to the parties involved.  However, Medicare rules related to hospital provider-based department status and the Pennsylvania Department of Health (DOH) Guidance Regarding Hospital Outpatient Department – Shared Space arrangements have severely limited what space sharing arrangements will continue to qualify under Medicare’s Hospital Outpatient Department (HOPD) billing rules.» Read More

The Centers for Medicare & Medicaid Services (CMS) released new data showing that it made a $313 million gain from the Medicare Shared Savings Program in 2017.  The 472 Medicare Accountable Care Organizations (ACOs) collectively generated savings of $1 billion and CMS paid $780 million in bonuses to the ACOs.» Read More

In response to the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, Centers for Medicare & Medicaid Services (CMS) has proposed new rules in an effort to curb the ongoing problem.  Click here to view the CMS Fact Sheet detailing the proposals.» Read More

On July 12, 2018, The Centers for Medicare & Medicaid Services (CMS) proposed a major overhaul of the way doctors have billed Medicare for patient visits for two decades. Some of the key provisions in the lengthy proposed rule include:

• simplifying the billing process to require less documentation that must be submitted by collapsing four separate levels of documentation requirements into one;
• allowing physicians to use their medical decision making or time spent with the patient to designate the level of patient care needed in lieu of using the traditional evaluation and management codes;
• paying physicians for certain telemedicine services; and
• continuing the site-neutral policy that pays off-campus facilities 40% of the outpatient rates for the services they provide to encourage “fairer competition between hospitals and physician practices by promoting greater payment alignment between outpatient care settings.”

If you have any questions concerning the proposed regulations, please contact me at sjarvaweiss@nmmlaw.com.» Read More

Those health care practitioners who have been unfortunate enough to be issued a demand for overpayment in a Medicare Summary Notice (“MSN”) are certain to eventually become aware of the arduous and lengthy process required to appeal such a determination.  A function of the huge backlog of appeals is that health care practitioners are routinely forced to wait several years before finally having their appeals heard by an Administrative Law Judge.  » Read More