| March 27, 2014 – Special Alert |
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Medicare & Reimbursement
Practical considerations to protect against being ‘out of network’
Practical considerations to protect against being ‘out of network’
The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare systems end on December 31, 2014. There are some hospital agreements that continue, such as those at Children’s and Magee, but the focus of…
President Obama Signs the Pathway for SGR Reform Act of 2013
By Michael Cassidy on
Posted in Medicare & Reimbursement
President Obama Signs the Pathway for SGR Reform Act of 2013
–New Law Includes Physician Update Fix through March 2014–
On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients…
Congress Passes 3 Month SGR Reprieve: .5% Medicare Physician Increase
By Michael Cassidy on
Posted in Medicare & Reimbursement
The AMA Wire reports the following action on the Medicare Physician Fee Schedule:
*3-month Medicare payment update approved for Jan. 1
*Congress has adopted a 0.5 percent update to Medicare payments for three months, following a bipartisan vote of 64 to 36 in the U.S. Senate Wednesday afternoon.
*The president is expected to sign…
SGR Update
By Michael Cassidy on
Posted in Medicare & Reimbursement
I recently posted the SGR White Paper published jointly by the Senate Finance Committee and the House Ways and Means Committee. Earlier this week, both committees endorsed legislation enacting those concepts.
The section by section summary of the SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 is attached. Unfortunately, both the House and…
Joint House and Senate SGR White Paper Proposes Permanent SGR Repeal
By Michael Cassidy on
Posted in Medicare & Reimbursement
The House Ways and Means Committee and the Senate Finance Committee have jointly issued a White Paper proposing the repeal of the Medicare Sustainable Growth Rate Formula, entitled “SGR Repeal and Medicare Physician Payment Reform”.
The SGR white paper acknowledges that the Sustainable Growth Rate formula is “fundamentally broken” and that application…
Highmark Launches Accountable Care Alliance
By Michael Cassidy on
Posted in Legal News, Medicare & Reimbursement
Highmark Launches Accountable Care Alliance
Attached is the press release;
https://www.highmark.com/hmk2/newsroom/pressreleases/2013/pr071813.shtml
More to come when the details are evaluaited.
CMS Proposes 2014 Medicare Physician Fee Schedule; SGR Reduction Projected @ 24.4%
By Michael Cassidy on
Posted in Medicare & Reimbursement
CMS has issued the poroposed Medicare Physician Fee Schedule. Without Congressional intervention, the SGR will mandate a 24.4% decrease. CMS sent its calcuations to the Medare Payment Advisory Commission.
CMS has also issued a Fact Sheet Summary:
DME Face-to-Face Delayed Until October 1, 2013
By Michael Cassidy on
Posted in Medicare & Reimbursement
Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for DME
Due to concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of Durable Medical Equipment (DME), CMS will start actively enforcing…
National Commission on Payment Reform Recommends 5 Year Transition Model
By Michael Cassidy on
Posted in Medicare & Reimbursement
The Society of General Internal Medicine convened the National Commission on Payment Reform to formulate a recommendation for healthcare payment reform. This Commission released its Report in March 2013. Although we have attached the report, here are the 12 fundamental recommendations.
1. Over time, payers should largely eliminate stand-alone fee-for-service payment to medical practices because of …