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CMMI’s Next Big Thing: Direct Provider Contracting

Last fall, the Center for Medicare and Medicaid Innovation (CMMI) asked the public to submit recommendations on the agency’s future direction.  On April 23, CMMI made public a 4,643-page document and a 6,380-line Excel spreadsheet containing the responses it received from approximately 1,000 individuals and organizations.  Stay tuned for our high-level summary of these comments. … Continue Reading

Risking Irrelevance?

Last November, we asked “Is CMS Changing Course on Value-Based Payments?”  We posed this question in response to a New York Times article highlighting how the Trump administration was slowing down and shrinking other Medicare pay-for-performance programs initiated under the Obama administration.  At the time, we offered four compelling reasons why providers should continue their efforts around … Continue Reading

2018 Medicare Physician Fee Schedule Final Rule: Care Management

On November 15, the Centers for Medicare & Medicaid Services (CMS) published its almost 400-page 2018 Medicare Physician Fee Schedule Final Rule.  Buried among those hundreds of pages, as has been the case for the last five years, the Final Rule again refines and expands Medicare reimbursement for care management services. Ambulatory Care Management Having … Continue Reading

CMS Cancels Episode Payment Models: Now What?

Back in June, when the Centers for Medicare & Medicaid Services (CMS) announced it would delay the effective date of the mandatory acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) bundles to January 1, 2018, the agency stated: [W]e disagree with commenters who suggested that CMS withdraw these models altogether and/or delay them … Continue Reading

4 Need-To-Know Provisions in the 2017 Medicare Physician Fee Schedule Final Rule

On November 15, CMS published its 393-page 2017 Medicare Physician Fee Schedule Final Rule.  Here are 4 need-to-know provisions likely to have a direct impact on practicing physicians in the upcoming year. 1. Conversion Factor Under the Medicare Access and CHIP Reauthorization Act of 2015, MPFS rates are scheduled to increase by one-half percent each … Continue Reading

MIPS Pick Your Pace: What Will You Choose to Do?

In response to complaints that the planned January 1, 2017, launch date for the new Medicare Merit-Based Incentive Payment Program (MIPS) is too much too fast, CMS Acting Administrator Andy Slavitt announced in a September 8 blog post the “Pick Your Pace” opportunity. According to Mr. Slavitt, MIPS-eligible clinicians – including nearly all physicians and … Continue Reading

2017 Medicare Physician Fee Schedule Proposed Rule: Expanded Payments for Care Management Services

Since 2013, the Centers for Medicare & Medicaid Services (CMS) has been expanding Medicare payments for care management services.  This trend continues in the 2017 Medicare Physician Fee Schedule Proposed Rule.  Specifically, CMS proposes the following: Simplify the chronic care management (CCM) billing rules. Pay for complex CCM. Pay for care plan development. Pay for … Continue Reading

2017 OPPS Proposed Rule: 4 Things to Know and 4 Things to Think About Regarding Site-Neutral Payments

The recently published 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule provides additional information regarding the site-neutral payment provisions included in Section 603 of the Bipartisan Budget Act of 2015. The Proposed Rule explains certain aspects of the provisions that will prohibit newly established off-campus hospital outpatient departments (HOPDs) from billing services and receiving payments … Continue Reading

CMS Fine Tunes Value Modifier as MIPS Prepares to Take the Stage

Since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) became law in April, all talk has been about the new Merit-Based Incentive Payment System (MIPS), which will replace the current Physician Value Modifier Program (VM Program) in 2019. For the next 3 years, however, the VM Program will determine provider payments.… Continue Reading
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