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CMS Finalizes Changes to Medicare Enrollment Rules

On December 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule concerning provider enrollment or re-enrollment in Medicare.   The final rule will give CMS the ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare, including those that have a managing […]

Continuing Saga of the Sustainable Growth Rate

The latest version of legislation to solve the Sustainable Growth Rate (“SGR”) has now been introduced in the House.  That version couples the resolution of the SGR problem with delaying the individual mandate under the Affordable Care Act.  While it is predicted that this legislation will pass the House, it is highly doubtful that this […]

Still No Sustainable Growth Rate Resolution

While there are proposals that Congressional leaders seem to be willing to adopt in regard to the Sustainable Growth Rate (“SGR”), they have not yet done so.  The relief that has been provided from the 24% cut in payments to physicians expires on March 31, 2014, unless something is done, including extending the deadline. As […]

Better Care at Lower Cost: If Patients Comply

New legislation is being introduced in the Senate by Democratic Senator Ron Wyden and Republican Senator Johnny Isakson and in the House by Democrat Peter Welch and Republican Erik Paulsen.  It is known as the Better Care Lower Cost Act of 2014.  The focus of the proposed legislation is the elimination of fee for service […]

Sustainable Growth Rate

It appears that half of the problem with the Sustainable Growth Rate has now been resolved.  Both the House and the Senate have agreed that there will be an annual update of .5% from 2014 through 2018.  The payment rates from 2018 would be maintained through 2023 during which times physicians could receive additional payments […]

Sustainable Growth Rate: An Update as to the Status of the Congressional Response

As you are aware, the implementation of the Sustainable Growth Rate (an approximately 30% reduction in payment to physicians in the Medicare program) was delayed until March 31st to provide an opportunity to permanently resolve the issue. Two competing bills have been reported in the House and the Senate (see our December 13, 2013 blog).  As […]

“Doc Fix” – The Continuing Saga of the Sustainable Growth Rate

To continue our reporting on the implementation of the Sustainable Growth Rate (“SGR”), as we write this on Friday the 13th, 2013, both the House and the Senate are considering bills, that would permanently address the SGR solution (euphemistically known as the “Doc Fix”).  The major difference between the two bills being considered is that […]

Massachusetts Provider Payment Controls: A Harbinger for the Future?

From a provider’s point of view, the issue of most concern under the Affordable Care Act (the “Act”) is the impact that the law will have on the compensation paid to providers for services rendered to the beneficiaries of either governmental or private insurance programs.  In light of the Supreme Court’s decision last week, there […]

PPACA Upheld by Supreme Court

Today, the United States Supreme Court issued its eagerly awaited decision in the case challenging the constitutionality of the Patient Protection and Affordable Care Act (“ACA”).  The Supreme Court has in effect upheld the constitutionality of the ACA, not by upholding the individual mandate, which requires individuals to maintain minimum levels of health insurance, but […]

The Train Has Left the Station

On Thursday, June 28th, the US Supreme Court is expected to issue its widely anticipated decision regarding the Affordable Care Act. I am currently attending the American Health Lawyers Association Annual Meeting in Chicago, where the changing landscape of healthcare is a hot topic. On Monday, we had former CMS Administrator Dr. Donald Berwick as […]

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