Physician Fee Schedule Proposed Rule Proposes New Quality-Driven Payment...
Within its proposed CY 2025 Physician Fee Schedule (PFS) rule (the Proposed Rule), CMS is proposing to implement new payment policies intended to advance health equity and support whole-person care....
View ArticleCMS Sneaks 340B Billing Proposals into Medicare Physician Fee Schedule: What...
On July 10, the Centers for Medicare & Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, which includes proposals related to identification of Medicare...
View ArticleCMS Proposes New CoP for Obstetrical Services: With Great Power Comes Great...
In case you need a reminder given everything going on in Washington, DC, the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) and CY 2025 Outpatient Prospective Payment System (OPPS) proposed regs...
View ArticleCMS Proposes Additional Revisions to the 60-Day Rule
The Centers for Medicare & Medicaid Services has issued its Calendar Year 2025 Medicare Physician Fee Schedule Proposed Rule, scheduled for publication in the Federal Register on July 31, 2024. In...
View ArticleCMS Releases CY 2025 Medicare Physician Fee Schedule Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (MPFS) and Other Revisions to Medicare...
View ArticleSubstance Use Disorder Treatment Services: 2025 Physician Fee Schedule...
On July 10, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Proposed Rule (Proposed Rule) for the calendar year 2025. The Proposed Rule would...
View ArticleCMS Proposes Extending COVID-Era Telehealth and Supervision Flexibilities...
The Centers for Medicare & Medicaid Services (CMS) proposed to extend a number of COVID-era regulatory flexibilities related to telehealth, remote services, and supervision in the CY 2025 Medicare...
View ArticleCMS Updates Master List for DMEPOS
The Master List for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) comes from a November 2019 final rule that created the list to serve as a library of items that have been...
View ArticleLegislative Uncertainty Slows Down, But Doesn’t Halt, Regulatory Action on...
Legislative Uncertainty on Telehealth Waivers Slows Down, But Doesn’t Halt, Regulatory Action on Virtual Care McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by...
View ArticleCMS Proposes Additional Modifications to the Overpayment Rule Relating to the...
In the context of Medicare Advantage (“MA”) reform initiatives, we previously addressed the Centers for Medicare & Medicaid Services’ (“CMS”) December 27, 2022 proposal to amend its regulations set...
View ArticleCMS Solicits Comments to Clarify Parameters on MAC Downcoding of Complex Drug...
In the proposed CY 2025 Physician Fee Schedule (PFS) published in the Federal Register on July 31, the Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposal to revise...
View ArticleCMS Proposes Significant Changes to the Medicare Shared Savings Program and...
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...
View ArticleDialysis & Nephrology Digest - August 2024
As value-based care (VBC) models continue to grow across our nation’s health system and specifically within different specialties like nephrology, the costs and challenges of maintaining these models...
View ArticleAffordable Care Act Overpayments in the CY 2025 Medicare Physician Fee...
Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and...
View ArticleCMS Rules Propose Changes Regarding the Medicare Prescription Drug Inflation...
On July 31, the Centers for Medicare and Medicaid Services (“CMS”) published its mammoth proposed rule entitled “Medicare and Medicaid Programs: Calendar Year 2025 Payment Policies under the Physician...
View ArticleCMS Revives, Expands Proposed Changes to Medicare Overpayment Rule
In response to comments on the 2022 proposed changes to the overpayments regulation, the Centers for Medicare & Medicaid Services (CMS) proposed additional changes to the overpayment rule to...
View ArticleKey Telehealth Updates in the CY 2025 Physician Fee Schedule Proposed Rule
On July 31, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (“Proposed Rule”) for the 2025 Medicare Physician Fee Schedule, which includes implications for...
View ArticleResponses to the PFS Proposed Reg Are In: 10 Major Comments
McDermott+ is pleased to bring you Regs & Eggs, a weekly Regulatory Affairs blog by Jeffrey Davis. Click here to subscribe to future blog posts. September 19, 2024 – Comments on the calendar year...
View ArticleNew Rule Curbs Impact of Suspect DME Claims on 2023 MSSP Financial Calculations
Effective October 15, a new Final Rule issued by the Centers for Medicare & Medicaid Services (CMS) will allow the Medicare Shared Savings Program (MSSP) to adjust calendar year (CY) 2023 benchmark...
View ArticleHospital and Health Systems Reimbursement Check - NOVEMBER 2024
Ropes & Gray attorneys share their analysis of administrative and court litigation, regulatory developments, key developments affecting federal program payments to hospitals and health systems, and...
View ArticleMedicare Overpayments: CMS Issues Final Regulations Implementing Changes to...
On Friday, November 1, 2024, the Center for Medicare & Medicaid Services (CMS) issued the display copy of the final rule interpreting the 60-day Refund Rule for Medicare Parts A/B (Traditional...
View ArticlePhysician Fee Schedule Payment System Data Dashboard
Have Medicare physician fee-for-service payment rates increased for X-ray services? How have remote patient monitoring prices evolved over the last five years? How much is your service paid in Alaska...
View ArticleCMS Releases CY 2025 Physician Fee Schedule Final Rule
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions...
View ArticleDigesting the Huge Buffet of CMS Regs: Highlights from the CY 2025 PFS Final Reg
While we all are focused on the election results, let’s take a quick break to digest some regs and eggs. The Centers for Medicare & Medicaid Services (CMS) “spoiled” all of us in the health policy...
View ArticleFederal Regulatory Update: CMS Medicare Payment Changes & Congressional Next...
The Centers for Medicare & Medicaid Services (CMS) have released significant updates affecting Medicare payments for 2025. The changes, outlined in two final rules, will impact both physicians and...
View ArticleMcDermott+ Check-Up: November 8, 2024
Republicans Win Control of White House and Senate, Seem Poised to Maintain Control of House. Former President Donald Trump will return to the White House, and Republicans also gained control of the...
View ArticleMedicare Decreases Physician Fee Schedule by 2.93%
The final Medicare Physician Fee Schedule was issued on November 1st for calendar year 2025. Attached is a link to both the Press Release describing all of the Medicare changes and the link to the...
View ArticleCMS Extends Remote Direct Supervision Flexibilities in CY 2025 Physician Fee...
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year 2025 final rule for services reimbursed under the Medicare physician fee schedule. Among other...
View ArticleFinal Medicare Overpayment Rules a Mixed Bag for Providers
The Centers for Medicare & Medicaid Services (CMS) released highly anticipated updates this month to the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the...
View ArticleAnother Trip to the Buffet: Highlights from the CY 2025 OPPS Final Reg
As mentioned last week, the Centers for Medicare & Medicaid Services (CMS) recently put out a large buffet of regs – too many to digest in one blog post. While we focused on the Calendar Year (CY)...
View ArticleCMS Releases CY 2025 Medicare Physician Fee Schedule Final Rule
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2024, released the calendar year (CY) 2025 Revisions to Payment Policies under the Physician Fee Schedule (MPFS) and Other Revisions to...
View ArticleDialysis & Nephrology Digest - November 2024
RPA Perspective: 2025 Medicare Fee Schedule and ESRD PPS Final Rules—Highlights for Nephrology - The final rule for the 2025 Medicare Physician Fee Schedule was released on November 1, and the...
View ArticleCMS Issues Final 2025 Calendar Year Medicare Physician Fee Schedule Final Rule
On November 1, 2024, CMS issued a rule finalizing changes to Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B policies effective on or after January 1, 2025 (the Final...
View ArticleCMS Bolsters Primary Care with Advanced Primary Care Management Coverage
On November 1, the Centers for Medicare & Medicaid Services (CMS) filed its Medicare Physician Fee Schedule (PFS) final rule (Final Rule) for calendar year (CY) 2025. As part of the Final Rule, CMS...
View ArticleCMS Makes Modifications to the Medicare Shared Savings Program
In its Final Rule for the 2025 Medicare Physician Fee Schedule, CMS announced changes to the Medicare Shared Savings Program (the Program) targeted at incentivizing providers to both enroll and stay in...
View ArticleThe 2025 Final Hospital Outpatient Prospective Payment System and Physician...
This past July, we reported on the Centers for Medicare & Medicaid Services (CMS) release of the 2025 proposed Hospital Outpatient Prospective Payment System (HOPPS) and Physician Fee Schedule...
View ArticleThe Impact of the Proposed 2025 Physician Fee Schedule on Parity and Delivery
Healthcare in the United States is undergoing significant changes, particularly in the areas of reimbursement and coverage of telehealth, substance use disorders (SUDs), and mental health services. The...
View ArticleCMS Finalizes Standard for Identifying Overpayments and Grace Period for...
As part of its 2025 Physician Fee Schedule Final Rule (PFS Rule), the Centers for Medicare & Medicaid Services (CMS) finalized two crucial updates to federal Medicare overpayments regulations...
View ArticleNew CMS Policies Position the MSSP for Expansion and Increased Savings
New policies tucked into the Centers for Medicare and Medicaid Services’ (CMS) 2025 Medicare Physician Fee Schedule Rule (Final Rule) will likely spur increased Accountable Care Organization (ACO)...
View ArticleTelehealth Update: DEA/HHS Temporary Rule, Medicare Coverage of Telehealth...
Telehealth companies and other industry stakeholders have had a watchful eye towards the end of 2024 and the impending “telehealth cliff” as COVID-era Drug Enforcement Agency (DEA) flexibilities and...
View ArticlePotential Medicare Physician Fee Schedule Reform in the Last Weeks of the...
A flurry of bills to reform the Medicare Physician Fee Schedule (PFS) faces the lame duck Congress. Our Health Care Group investigates how those reforms could take shape and which, if any, could find...
View ArticleCMS Finalizes Virtual Direct Supervision Extension and Rule Changes
On November 1, the Centers for Medicare & Medicaid Services (CMS) finalized its proposal to extend virtual direct supervision—i.e., the ability to provide direct supervision through real-time,...
View Article2025 Medicare Physician Fee Schedule: Payment and Overpayment Policies
On December 9, 2024, the Centers for Medicare & Medicaid Services' (CMS's) Calendar Year 2025 Physician Fee Schedule Final Rule (the Final Rule) was published in the Federal Register. The Final...
View ArticleNavigating New Medicare Overpayment Rules and Practical Tips to Comply
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute)...
View ArticleDeadline Approaches for Expiring Medicare Telehealth Waivers: What Providers...
During the COVID-19 pandemic, both federal and state governments enacted a host of laws and implemented flexibilities to ensure health care providers, hospitals, and health systems could move...
View ArticleRegulatory Implications of the Continuing Resolution Healthcare Package
Earlier this week, Congress released the text of a continuing resolution that includes a more-robust-than-anticipated healthcare package. While the bill’s primary purpose is to keep the government open...
View ArticleNew Year Brings Material Changes to Medicare Overpayment Rule
The Centers for Medicare and Medicaid Services (CMS) finalized material changes to the overpayment rules for Medicare Parts A, B, C, and D effective January 1, 2025. These changes create new ambiguity...
View ArticleA New Year, A New Overpayment Rule: CMS Revises the 60-Day Rule
On December 9, the Centers for Medicare & Medicaid Services (CMS) published revised regulations implementing the so-called 60-day rule, under which healthcare providers and other parties generally...
View Article2025 Medicare Final Rule Highlights
CMS issued its Final Rule for the 2025 Medicare Physician Fee Schedule in November. Originally published in the Allegheny County Medical Society (ACMS) Bulletin - December 2024....By: Tucker Arensberg,...
View ArticleDialysis & Nephrology Digest - January 2025
Happy New Year and welcome to our 2024 Trade Secret and Restrictive Covenant Year in Review. 2024 was less stressful and dramatic than most people feared at the start of the year, but there still were...
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