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Iowa Healthcare Law Blog News & Updates on Legal, Policy, & Business Issues Facing the Health Care Industry in Iowa

Category Archives: Centers for Medicare and Medicaid Services-CMS

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President-Elect Trump Names Rep. Tom Price, MD (R-GA) as HHS Secretary, Seema Verma, Health Care Consultant, as CMS Administrator

Posted in Affordable Care Act (ACA), American Medical Association, Centers for Medicare and Medicaid Services-CMS, Health and Human Services (HHS), MACRA - Medicare Access and CHIP Reauthorization Act

Medicare/Medicaid Reform and ACA Repeal on the Horizon, MACRA Moves Forward for Now The new administration’s agenda for health care may have come into clearer focus with President-Elect Donald Trump’s nomination of House Representative Tom Price, MD, a Republican from Georgia, as Secretary of Health and Human Services (HHS) and Seema Verma, MPH, as CMS… Continue Reading

Time Remains to File a request for Informal Review of CY 2017 PQRS Negative Payment Adjustment

Posted in Centers for Medicare and Medicaid Services-CMS

QRUR Informal Review Also Available. Physicians and other eligible professionals and practices who failed to meet criteria for satisfactory PQRS reporting in calendar year (CY) 2015 now face a negative 2% adjustment in Medicare Part B payments for CY 2017. Physicians who believe CMS has inappropriately determined that a negative PQRS payment adjustment applies to… Continue Reading

CMS publishes Final MACRA Rule for MIPS and APM Incentives

Posted in Centers for Medicare and Medicaid Services-CMS, Electronic Health Records, Health and Human Services (HHS), Healthcare costs, Medicaid

On October 14, 2016, the Centers for Medicare & Medicaid Services (CMS) released its final rule implementing the new Quality Payment Program for physicians in lieu of the repealed sustainable growth rate factor (SGR). Rather than facing substantial annual reductions in Medicare payment fees as a result of the SGR, physicians now have two interrelated… Continue Reading

MACRA ON THE MOVE!

Posted in Centers for Medicare and Medicaid Services-CMS, Electronic Health Records, Healthcare costs, MACRA - Medicare Access and CHIP Reauthorization Act

CMS proposed rule details Medicare’s new physician “Quality Payment Program” Reporting under new measures slated to begin in 2017 The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for Medicare payment to physicians, released a proposed rule on April 27, 2016, setting forth key provisions of its Quality Payment Program for physicians,… Continue Reading

Medicare “Incident To” Billing – CY 2016 Clarifications

Posted in Centers for Medicare and Medicaid Services-CMS

The billing physician must be the supervising physician. The final CY (calendar year) 2016 Medicare physician payment rule is out and published in the November 16, 2015 Federal Register. In that rule, CMS (Centers for Medicare & Medicaid Services) made two changes clarifying Medicare’s Part B “incident to” billing rule found at 42 CFR 410.26…. Continue Reading

CMS REQUIRES MEDICAID PROGRAMS ACCESS MONITORING PLANS BY JULY 1, 2016

Posted in Centers for Medicare and Medicaid Services-CMS, Medicaid

State plans must consider impact of provider rates on beneficiary access US Supreme Court says providers cannot challenge Medicaid payment rates in a court of law Physicians under Iowa’s Medicaid program consistently provide quality medical care to our State’s 560,000 Medicaid beneficiaries despite payment rates that, according to the Iowa Medical Society, are nearly the… Continue Reading

CMS Releases Proposed CY 2016 Medicare Physician Payment Rule

Posted in Centers for Medicare and Medicaid Services-CMS

A Topical Rundown On July 8, 2015, CMS released its calendar year (CY) 2016 proposed Medicare physician payment rule in prepublication form; the rule will be formally published in the July 15 Federal Register. Comments on the proposed rule are due on September 8, 2015. The prepublication version of the proposed rule can be found… Continue Reading

Is Health Plan Identifier (HPID) required for Self-Funded Medical Plan?

Posted in Centers for Medicare and Medicaid Services-CMS

Some time ago, we were asked by a reader, “Is an employer self-funded medical plan required to have a Health Plan Identifier (HPID)?” We thought this general information might be helpful. Please remember this information and blog is NOT LEGAL ADVICE, and you should consult with your own attorney. The inquirer correctly notes that the… Continue Reading

SENATE PASSES H.R. 2, IMMEDIATELY REPEALING THE SGR, EXTENDING 1.0 WORK FLOOR GPCI

Posted in Centers for Medicare and Medicaid Services-CMS, Healthcare costs, MACRA - Medicare Access and CHIP Reauthorization Act

The Senate passed H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), on a vote of 92-8. Iowa’s Senators Joni Ernst and Charles Grassley voted in favor of the bill. The Senate considered amendments to the bill as passed by the House, but none were adopted. The H.R. 2 now goes to the President… Continue Reading

Bipartisan House Vote to Repeal SGR – 0.5% Physician Annual Increase

Posted in Centers for Medicare and Medicaid Services-CMS, Healthcare costs, ICD-10

BIPARTISAN HOUSE VOTE TO REPEAL THE SGR – 0.5% PHYSICIAN INCREASE EACH YEAR THROUGH 2019 — EXTENSION OF THE 1.0 WORK GPCI FLOOR THROUGH 2017 – NO ICD-10 DELAY Senate to Vote When It Returns – CMS Issues Payment Advisory The House of Representatives took what the House of Medicine rightfully can call a historic… Continue Reading

BIPARTISAN HOUSE VOTE TO REPEAL THE SGR

Posted in Centers for Medicare and Medicaid Services-CMS, Healthcare costs, ICD-10

.05% PHYSICIAN INCREASE EACH YEAR THROUGH 2019 EXTENSION OF THE 1.0 WORK GPCI FLOOR THROUGH 2017 NO ICD-10 DELAY Senate to Vote When It Returns – CMS Issues Payment Advisory The House of Representatives took what the House of Medicine rightfully can call a historic vote late in the evening of March 26 to really,… Continue Reading

Update on CoOportunity Health

Posted in Affordable Care Act (ACA), Centers for Medicare and Medicaid Services-CMS, CO-OP (Consumer Operated and Oriented Plan)

Update – Insurance Commissioner requests CoOportunity liquidation – district court to decide in late February Concluding that insufficient funds currently exist to meet its obligations to pay medical claims, Iowa Insurance Commissioner, Nick Gerhart, filed a petition in Polk County District Court on January 29, 2015, concluding that further efforts toward rehabilitation of CoOportunity would… Continue Reading

CoOportunity Health Now Under State Insurance Division Management

Posted in Affordable Care Act (ACA), Centers for Medicare and Medicaid Services-CMS, CO-OP (Consumer Operated and Oriented Plan)

CoOportunity Health In what came as a surprise to many, Iowa’s Insurance Commissioner, Nick Gerhart, filed a petition in Polk County District Court on December 23, seeking court authorization under state insurance laws to assume management authority over CoOportunity Health, Inc., toward the end of rehabilitating the company’s substantially declining financial stability. The district court… Continue Reading

MEDICARE EHR MEANINGFUL USE PENALTY NOTICES – REDUCTIONS IN PAYMENT TO BEGIN ON JANUARY 5TH

Posted in American Medical Association, Centers for Medicare and Medicaid Services-CMS, Electronic Health Records, Medical Records

MEDICARE EHR MEANINGFUL USE PENALTY NOTICES ON THEIR WAY TO 257,000 On December 21, the federal Centers for Medicare & Medicaid Services (CMS) began issuing letters to physicians and other health professionals eligible to participate in the Medicare EHR Incentive Program notifying them of a 1% Medicare payment penalty they will incur in 2015 for… Continue Reading

CMS Establishes a new Office of Enterprise Data Analytics (OEDA)

Posted in Affordable Care Act (ACA), Centers for Medicare and Medicaid Services-CMS

CMS announced in November the formation of a new Office of Enterprise Data Analytics (OEDA) and named Niall Brennan as the OEDA’s chief data officer. The OEDA’s overarching goal is to harness CMS’ vast data resources for internal and external use as CMS continues to move away from volume-based to value-based care. Brennan, who has served in… Continue Reading

Medicare Shared Savings Program Update – Iowa

Posted in Accountable Care Organizations (ACO), Centers for Medicare and Medicaid Services-CMS, Medicare Shared Savings Program (MSSP)

PROPOSED CHANGES TO THE MEDICARE SHARED SAVINGS PROGRAM (MSSP) – COMMENTS DUE BY FEBRUARY 6 – SHARED SAVINGS BY IOWA ACOS On December 1, 2014, CMS released a rule proposing several significant changes to the Medicare Shared Savings Program (MSSP) and calling for input on options under consideration to encourage greater participation in two-sided risk sharing… Continue Reading