Posts in CMS Programs
FQHCs and RHCs now paid for Telehealth and Virtual Communications Services during COVID-19
FQHCs and RHCs now paid for Telehealth and Virtual Communications Services during COVID-19

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) passed by Congress on March 27, 2020 opened the door for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to increase healthcare access to patients in rural and underserved areas by reimbursing for telehealth services to Medicare beneficiaries during the public health emergency (PHE). In addition, CMS has issued non-legislative policy changes and flexibility to address the increased need for remote services for Medicare beneficiaries in rural areas of the country.

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COVID-19, CMS Programs, Digital Health, Healthcare Reform, Remote Patient Monitoring, TelehealthRebecca GwiltCoronavirus, COVID-19, Telehealth, virtual care, communications, RPM, Remote Patient Monitoring, CMS, Rebecca Gwilt
Telehealth, Virtual Visits, e-Visits, and Remote Care for Nursing Homes during the COVID-19 Public Health Emergency (PHE)
Telehealth, Virtual Visits, e-Visits, and Remote Care for Nursing Homes during the COVID-19 Public Health Emergency (PHE)

The burden on the staff and residents of long-term care facilities, including nursing facilities and skilled nursing facilities, has increased significantly around the country. The Centers for Medicare and Medicaid Services (CMS), in response to feedback from industry stakeholders, and under new 1135 waiver authorities granted to it in the Coronavirus Preparedness and Response Supplemental Appropriations Act, implemented several policy changes to support long term care facilities, including changes enabling practitioners to remotely provide services to these facilities and to remotely supervise on-site providers. 

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COVID-19, Assisted Living, CMS Programs, Digital Health, Healthcare Reform, Medicare, Regulations, Reimbursement, TelehealthRebecca GwiltCoronavirus, COVID-19, nursing home, Teleheath, virtual check-in, e-Visit, remote care
NEW! Medicare to Reimburse for Acupuncture Services
NEW! Medicare to Reimburse for Acupuncture Services

On January 21, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized a decision (under National Coverage Determination (NCD) 30.3.3) to cover acupuncture for Medicare patients, specifically those with chronic low back pain (cLBP).

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CMS Programs, Healthcare Reform, Medicare, ReimbursementTommy MillerCMS, Reimbursement, Medicare, chronic condition, back pain, CPT code 97810, CPT code 97811, CPT code 97813, CPT code 97814
How to Get Paid for Patient "e-Visits" under the 2020 Medicare Physician Fee Schedule
How to Get Paid for Patient "e-Visits" under the 2020 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) released the Final Medicare Physician Fee Schedule for CY 2020 (the “2020 MPFS”) on November 1, 2019. The 2020 MPFS finalizes six new CPT codes for e-Visits, providing new opportunities for physician practices to be reimbursed for conducting digital health assessments and evaluations for their patients and for remote patient monitoring companies to add these capabilities to their platforms.

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CMS Programs, Healthcare Law Firm, Medical Practice, Medicare, Physician Fee Schedule, Physicians, Regulations, Remote Patient Monitoring, ReimbursementKaitlyn O'ConnorRemote Patient Monitoring, Remote Monitoring, RPM, Digital Health, virtual care, 2020 MPFS, 2020 Medicare Physician Fee Schedule, Coronavirus
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. 

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CMS Programs, Healthcare Reform, RegulationsTommy MillerHHS, Stark Law, CMP, OIG, dhhs, CMS, Anti-Kickback, proposed rule, Safe Harbor, AKS Safe Harbor
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.

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FDA, CMS Programs, Healthcare ReformTommy MillerLife Sciences and Biotech, CMS, Reimbursement, medical device, pharmaceutical
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.

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CMS Programs, Healthcare Reform, Medicare, Physicians, Medical Practice, Regulations, ReimbursementCarrie NixonHealthcare innovation, CMS, Medicare, medicaid, regulations
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.

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CMS Programs, Medicare, Regulations, ReimbursementCarrie NixonMSSP, Medicare ACO, Medicare Shared Savings Program, BASIC Track, ENHANCED Track, CMS
Top Changes to 2018 Medicare Physician Fee Schedule
Top Changes to 2018 Medicare Physician Fee Schedule

The 2018 Medicare Physician Fee Schedule Final Rule (“2018 MPFS” or “Final Rule”) went into effect on January 1. Marked by new additions to the Telehealth codes and the un-bundling of Remote Patient Monitoring code CPT 99091, the 2018 MPFS provides plenty of opportunities for providers to grow their practice through digital medicine. This article outlines key changes to the new Rule. 

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Remote Patient Monitoring, Telehealth, CMS Programs, Physician Fee ScheduleKaitlyn O'ConnorNixon Law GroupMedicare, Remote Patient Monitoring, Telehealth, CMS, digital medicine