All eyes are on the new physician fee schedule proposed by the Centers for Medicare & Medicaid Services (CMS), which will be finalized this year and go into effect Jan. 1. The ACR is reviewing the proposal and will be providing comments and recommendations to CMS. And many rheumatologists have payment and coding questions: Will…
Medicare Sets Standards for Overpayments Received by Physicians, Healthcare Providers
In February 2016, the Centers for Medicare & Medicaid Services (CMS) published the final rule on Medicare Reporting and Returning of Self-Identified Overpayments. This final rule from CMS has now established official policy for timely reporting and returning of Medicare overpayments received by healthcare providers, with a goal to provide clear requirements for reporting and…
The ACR Opposes Part B Payment Demo & Other Highlights from the AMA HOD Meeting
On June 15, the ACR and partnering physician specialist groups passed an American Medical Association (AMA) resolution opposing the proposed Medicare Part B drug payment demonstration during the AMA House of Delegates (HOD) meeting held June 11–15 in Chicago. Part B Payment Demo Resolution The resolution, which the ACR supported with the American Society of…
Prepare Now to Survive MACRA
The year 2015 brought an end to the much-maligned Sustainable Growth Rate (SGR), sometimes known as the “doc fix.” The SGR established limits on Medicare reimbursement for physicians, and each year, physicians and those lobbying on their behalf were forced to stave off drastic cuts to their payments. “The SGR was Congress’s attempt to control…
CMS Commences 45-Day Open Payments Review & Dispute Period
On April 1, the Centers for Medicare and Medicaid Services (CMS) announced the beginning of the 45-day Open Payments Review and dispute period, which will conclude on May 15. After the review period concludes, on June 30, CMS will publish 2015 payment data along with updates to the 2013 and 2014 data. If you are…
U.S. Health Agency Estimates 2015 Prescription Drug Spending Rose to $457 Billion
NEW YORK (Reuters)—Spending on prescription drugs is projected to have risen to $457 billion in 2015 and will likely continue to grow as a percentage of overall healthcare spending, a U.S. government health agency said on Tuesday. That is an increase of about 8% from 2014’s prescription drug spending, which is also an estimated figure,…
U.S. Proposes Hike in Medicare Advantage Payments; Insurer Shares Rise
NEW YORK (Reuters)—The U.S. government on Friday proposed raising payments by 1.35% on average next year to the health insurers who offer Medicare Advantage health benefits to elderly and disabled Americans. Payments to insurers will vary under the 2017 Medicare Advantage proposal, based on the region the plans are sold and on the size of…
Theranos Lab May Pose Jeopardy to Patient Health
(Reuters)—Deficient practices at a lab operated by blood-testing startup Theranos pose “immediate jeopardy to patient health and safety,” the U.S. government’s Centers for Medicare & Medicaid Services said in a letter to the company released on Wednesday. Theranos, founded and led by Elizabeth Holmes, has been in the spotlight after reports in the Wall Street…
Important Changes to the Meaningful Use Hardship Exception
As a result of recent Medicare legislation, the Center for Medicare & Medicaid Services (CMS) has launched important changes to the Meaningful Use hardship exception process, featuring a more streamlined application process. These changes will reduce the burden on eligible professionals (EPs) by condensing the application process and decreasing the amount of information that must…
2016 Deadline Imposed by Meaningful Use Program Requires Immediate Attention: Sign Up for 2 Registries by Feb. 29 or Expect Financial Penalty
Meaningful Use may be changing but it is not going away—yet. Rheumatologists must sign up with two of three registries by Feb. 29 or pay significant financial penalties for not complying with this specific part of the Meaningful Use requirements. The three choices for registries include the Immunization Registry, the Syndromic Surveillance Registry and a…
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