On July 14, 2025, the Centers for Medicare & Medicaid Services (“CMS”) released the proposed rule for the Calendar Year (“CY”) 2026 Medicare Physician Fee Schedule (“PFS”), formally titled CMS-1832-P....more
On June 22, 2023, the US House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations held a hearing titled “MACRA Checkup: Assessing Implementation and Challenges that Remain for...more
CMS recently announced updates and milestones for several programs run by the Center for Medicare and Medicaid Innovation (CMMI). CMMI is the internal CMS agency responsible for developing and testing new health care payment...more
The Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2019, published the Calendar Year (CY) 2020 Final Rule for the Medicare Physician Fee Schedule (MPFS). The MPFS dictates Medicare rates and policies under Part B,...more
In this week’s episode, Steve Pine presents the last installment of our three part series addressing the CMS Quality Payment Program (QPP) updates in the CY2020 Physician Fee Schedule (PFS) Proposed Rule. In this episode, Mr....more
• On July 18, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare & Medicaid Innovation (CMMI) published a proposal to implement a new mandatory Medicare payment model in select geographic...more
• The Centers for Medicare & Medicaid Services (CMS) has published the Calendar Year (CY) 2019 Final Rule for the Medicare Physician Fee Schedule (PFS), which includes provisions related to Medicare physician payments as well...more
The Centers for Medicare & Medicaid Services (CMS) on July 12, 2018, published the CY 2019 Proposed Rule for the Medicare Physician Fee Schedule (PFS). While in previous years regulations for the Quality Payment Program (QPP)...more
The State of Maryland is unique in its historical experimentation with rate setting and global budgets for hospitals, and that experimentation continues with the Maryland Total Cost of Care Model (TCOC). Beginning January...more
Most physicians have, by this point, gained some familiarity with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The name of this law has appeared frequently in commentary over the past several years, and...more
2018 marks the commencement of the second performance year for the Medicare Quality Payment Program (QPP), implemented under the Medicare Access and CHIP Reauthorization Act of 2015 (otherwise known as MACRA). ...more
On November 2, 2017, CMS issued the final rule with comment for the second year (2018) of the Quality Payment Program as well as an interim final rule. Continuing with its theme of a CMS that is “listening to feedback,” CMS...more
On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Quality Payment Program (QPP) Final Rule. The Final Rule contains notable changes that may affect smaller practices participating in...more
The Center for Medicare & Medicaid Innovation (CMMI) is seeking ideas on how to better drive change and reduce regulatory burden. CMMI solicited ideas to shape the agency’s future activities through a September 2017 “request...more
On June 20, 2017, CMS released its proposed rule updating MACRA’s Quality Payment Program (“QPP”) for CY 2018. At over 1,000 pages, the rule might not do much to simplify the already complex requirements of the QPP; however,...more
On June 20, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-5522-P) that would make changes to the second year requirements of the Medicare Access and CHIP Reauthorization Act of 2015...more
Payment models that seek to reward physicians, hospitals and other health care providers for achieving certain quality and cost-saving goals, or “value-based purchasing” (VBP), are not new to the healthcare landscape,...more
On November 14, 2016, CMS published its final rule implementing the physician payment provisions of the Medicare Access and CHIP Reauthorization Act (“MACRA”). The rule became effective January 1, 2017. Data collection from...more
If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary. Medicare...more
Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more
The Centers of Medicare and Medicaid Services (CMS) released the much-anticipated Medicare Access and CHIP Reauthorization Act (MACRA) final rule this month. The rule makes extensive changes to traditional Medicare Part B...more
MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) is bi-partisan legislation that was enacted to change Medicare reimbursement from being based on the current system of volume of services provided to...more
The Centers for Medicare & Medicaid Services (CMS) recently released its final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among its numerous changes,...more
Many observers view the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a game changer for the delivery and payment of health care services. On Oct. 14, 2016 the Centers for Medicare & Medicaid Services...more
On the heels of the release of its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare and Medicaid Services (CMS) released its 2017 list of Advanced Alternative Payment...more