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CMS Programs

HHS Proposes New Safe Harbors Under the Anti-Kickback Statute and The Stark Law

HHS Proposes New Safe Harbors Under the Anti-Kickback Statute and The Stark Law

In a pair of proposed rules released by the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS), the DHHS is looking to increase the utilization of value-based arrangements to drive health outcomes and ease the regulatory burdens associated with patient care coordination.  The proposed rules seek to change or add certain safe harbors or exceptions to the Anti-Kickback Statute (AKS), Physician Self-Referral prohibition (Stark Law), and the Civil Monetary Penalties (CMP) laws. 

CMS’ New Coding Policy Will Speed up Reimbursement for New Drugs and Devices

CMS’ New Coding Policy Will Speed up Reimbursement for New Drugs and Devices

When developing new medical device and drug products, it is important to understand how the product will be adopted and paid for in the marketplace. The development of new drugs and devices involves countless hours researching, testing, modifying, iterating, and testing some more… In larger companies, whole teams of people also dedicate the same effort into developing a market access plan—meaning careful planning for manufacturing, distribution, and insurance contracting.  This strategic planning can be overlooked in start-up biotech companies operating on limited resources and which are squarely focused on innovating new technologies.

New CMS Innovation Models: Primary Care First and Direct Contracting

New CMS Innovation Models: Primary Care First and Direct Contracting

In April, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced a new set of payment models meant to allow primary care providers deliver better care at a lower cost to their patients by removing unneccessary administrative and adjust payouts from procedures to outcomes.

MSSP Proposed Rule may mean major changes for Medicare ACOs

MSSP Proposed Rule may mean major changes for Medicare ACOs

CMS recently released a Proposed Rule suggesting significant changes to the Medicare Shared Savings Program, aimed at accelerating the path for providers participating in a Medicare ACO to take on risk for the cost and care of their patient populations. The following is a summary of key changes proposed to the MSSP.

Medicare Data Sharing under the CMS Qualified Entity Program

Medicare Data Sharing under the CMS Qualified Entity Program

The Qualified Entity Program allows CMS-certified Qualified Entities to obtain and use Medicare claims data to conduct non-public analyses and provide or sell combined data/analyses, consistent with certain program requirements.

MACRA for Physicians, Part Three

MACRA for Physicians, Part Three

In Part Three of the MACRA series, you’ll learn about Advanced Alternative Payment Models (APMs) and the requirements for participating in this track, along with how doing so will affect your Medicare payments for 2017 and beyond.