Michael Cassidy on Medicare

2025 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....more

1/13/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Health Insurance , Healthcare , Healthcare Reform , Medicare , Medicare Advantage , Physician Fee Schedule , Physicians

Medicare Telehealth Reimbursement Update

Our Introduction to Telehealth, Technology and Federal Enforcement chapter was published in the Thomson Reuters 2025 Health Law Handbook. It reviewed a number of telehealth Medicare revisions, both permanent and temporary,...more

11/21/2024 / Coronavirus/COVID-19 , Medicare , Physician Fee Schedule , Proposed Legislation , Telehealth , Telemedicine

Medicare 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 entire Final Rule....more

11/12/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Medicare , Physician Fee Schedule , Physician Medicare Reimbursements , Physicians

Medicare Proposes 2.8% Physician Fee Schedule Reduction

See below for the CMS (Centers for Medicare & Medicaid Services) Announcement on July 10, 2024 proposing a reduction in the Medicare Conversion Factor payment from $33.29 to $32.36, i.e. 2.8%...more

7/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians , Proposed Rules

Medicare Proposed 2025 Telehealth Changes

CMS proposed several telehealth changes in the 2025 Medicare Physician Fee Schedule Proposed Rule, issued July 10, 2024....more

7/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Amendments , Telehealth , Telemedicine

Medicare Conversion Factor Increased to $33.2875

The 2024 Consolidated Appropriations Act passed and signed on Saturday, March 23, 2024, increased of Medicare Conversion Factor from $32.7442 to $33.2875, an increase of slightly over $0.54....more

3/28/2024 / Consolidated Appropriations Act (CAA) , Medicare

2024 Medicare Physician Fee Schedule - Update

CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be...more

11/6/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Physician Fee Schedule , Physicians

2024 Medicare Physician Fee Schedule

The 2024 Medicare Physician Fee Schedule proposes a 3.34% decrease in the 2024 PFS conversion factor. It’s currently $33.89 and is proposed to be reduced to $32.75....more

7/17/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Medicare Physician Fee Schedule Reductions Partially Offset

The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. ...more

1/11/2023 / Health Care Providers , Medicare , Physician Fee Schedule , Physicians

Medicare Proposes 2023 Physician Pay Cuts

On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor. ...more

7/22/2022 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Physician Fee Schedule , Physicians

2022 Budget Bill Includes Mandatory Healthcare Cyber Incident Reporting

The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions. The definition of “covered entity” in the...more

4/5/2022 / Covered Entities , Cyber Attacks , Cyber Incident Reporting , Cybersecurity Information Sharing Act (CISA) , Department of Homeland Security (DHS) , Federal Budget , Health Care Providers , Health Insurance Portability and Accountability Act (HIPAA) , Medicare

Congress Extends Telehealth Coverage

The President and Congress extended Medicare telehealth coverage in the Consolidated Appropriations Act, which also included additional Ukrainian relief. On Tuesday, March 15, 2022, President Biden signed the Consolidated...more

3/21/2022 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Health Care Providers , Medicare , Physicians , Telehealth , Telemedicine , Time Extensions

2022 Medicare Rules for Facility-Based Split/Shared Visits

There has been much discussion and controversy over the new CMS position on billing for split/shared services in facility settings. As originally proposed, and starting in January 2022, if the service was shared among...more

1/24/2022 / Billing , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Healthcare Facilities , Medicare , Physicians

CMS Resumes Targeted Probe and Education (TPE) Program

In the August 12, 2021 MLN Connects News, CMS announced resumption of TPE Program. ...more

8/17/2021 / Centers for Medicare & Medicaid Services (CMS) , Compliance , Health Care Providers , Medicare , Targeted Probe and Education (TPE) audit

Medical Practices Face Liability for COVID Accelerated and Advance Payments and PPP Loans

Medical practices are now beginning to encounter Medicare payment claw backs by CMS for COVID Accelerated and Advanced Payments (CAAP) and Department of Justice (DOJ) prosecution for Paycheck Protection Program (PPP)...more

4/22/2021 / Advanced Payment Program , Centers for Medicare & Medicaid Services (CMS) , Clawbacks , Coronavirus/COVID-19 , Criminal Liability , Criminal Prosecution , Department of Justice (DOJ) , Fraud and Abuse , Health Care Providers , Medicare , Paycheck Protection Program (PPP)

2021 Medicare Fee Schedule Conversion Factor Reduction Reversed

CY 2021 Physician Fee Schedule Update - On December 27, 2020, the Consolidated Appropriations Act modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS)...more

1/15/2021 / Centers for Medicare & Medicaid Services (CMS) , Medicare , Physician Fee Schedule , Physicians

Proposed 2021 Medicare Physician Fee Schedule Changes

Attached is a link to the fact sheet for “proposed policy, payment, and quality provisions changes to Medicare physician fee schedule for calendar year 2021”. Among other things, Centers for Medicare & Medicaid Services...more

8/13/2020 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule , Proposed Amendments

CMS 2021 Fee Schedule Expands ASC Procedures

Centers for Medicare & Medicaid Services (CMS) published the new hospital outpatient and ambulatory surgical center fee schedule for 2021 on August 12, 2020. As part of the proposed revisions, CMS intends to transfer over...more

8/13/2020 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Fee Schedule

It Is Not Illegal to Pay Physicians More Than They Generate

While we are waiting for final disposition of the AKS Safe Harbors and Stark Exceptions proposed in October of 2019, since the comment period expired December 31, 2019 and final rules have not been issued, I thought we should...more

3/6/2020 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Comment Period , Department of Health and Human Services (HHS) , Exceptions , Fair Market Value , Hospitals , Medicare , Physicians , Proposed Rules , Safe Harbors , Stark Law

Telehealth Update: Connect for Health Act

A bipartisan group of senators has introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019. A summary produced by that bipartisan group is attached....more

12/12/2019 / Children's Health Insurance Program (CHIP) , Community Health Systems , Healthcare Facilities , Medicare , Medicare Access and CHIP Reauthorization (MACRA) , Medicare Advantage , Proposed Legislation , Rural Health Care Program , Rural Health Care Providers , Telehealth

Regulatory Sprint to Coordinated Care: CMS/AKS and OIG Stark Proposed Amendments

HHS has long admitted that the Anti-Kickback Statute (AKS) and the Stark law have not evolved to keep pace with the transition to value based care. In June of 2018, HHS issued an RFI seeking additional information and HHS...more

10/23/2019 / Anti-Kickback Statute , Department of Health and Human Services (HHS) , Fair Market Value , Health Care Providers , Health Insurance Portability and Accountability Act (HIPAA) , Medicaid , Medicare , OIG , Safe Harbors , Value-Based Care

CMS Expands Medicare Advantage Telehealth Coverage

On April 4, 2019, CMS issued the final Medicare Advantage Rule for calendar year 2020, announcing it will allow Medicare Advantage carriers to significantly increase the range of telehealth services beyond traditional...more

4/30/2019 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Medicare , Medicare Advantage , Telehealth , Telemedicine

Medicare Updates Ambulatory Surgical Center (ASC) Payment Systems

On Thursday, March 28, CMS issued a new MLN Connects article, which included updates for ambulatory surgery center payments. A link is attached below...more

3/29/2019 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Medicare

Updated Procedural History of UPMC – Highmark Litigation

Below is a summary of UPMC-Highmark dispute as of March 4, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations....more

3/4/2019 / Affordable Care Act , Consent Decrees , Due Process , Employee Retirement Income Security Act (ERISA) , Equal Protection , Highmark , Legal History , Medicare , Medicare Advantage , Preemption , Preliminary Injunctions , Sherman Act , Takings Clause

CMS Issues Hospital Price Transparency Rules

As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019. CMS explained...more

1/11/2019 / Centers for Medicare & Medicaid Services (CMS) , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare , Surprise Medical Bills , Transparency

Michael Cassidy

Tucker Arensberg, P.C.

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