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Under 2022 Medicare Physician Fee Schedule, Physician Assistants Will Be Paid Directly for Services
On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released its Final Medicare Physician Fee Schedule for 2022 (the “Final 2022 MPFS”), revising certain payment policies for services provided to Medicare beneficiaries by healthcare practitioners. These policies take effect on January 1, 2022.
New Reimbursement for Remote Therapeutic Monitoring in the Final 2022 Medicare Physician Fee Schedule
This article examines the new CPT codes for Remote Therapeutic Monitoring as finalized for reimbursement in the 2022 Medicare Physician Fee Schedule, discussing key takeaways and implications for digital health and remote patient monitoring companies.
What New Jersey Telehealth and Virtual Care companies need to know about the October 15 registration deadline *Note: Deadline extended to January 3, 2022*
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[Video] Digital Health Innovators: Does your solution qualify as Software as a Medical Device (SaMD)?
If you’re in the Remote Patient Monitoring (RPM) or Remote Therapeutic Monitoring (RTM) space, then you’ll want to understand the criteria and opportunities for qualifying as Software as a Medical Device (SaMD)
Remote Therapeutic Monitoring in the 2022 MPFS: How CMS Can (and Should) Get it Right
This is our take on the approach CMS should follow in improving and finalizing the RTM codes and associated reimbursement that improve patient outcomes and lower the overall cost of care. It is based on our extensive work with remote patient monitoring and care management digital health companies along with the physician practices who use the existing care management codes – including Remote Patient Monitoring (“RPM”), Chronic Care Management, Principal Care Management, and Behavioral Health Integration.
Intellectual Property for Digital Health Companies: How a Multi-Faceted Strategy Balances Patentability Barriers
If you’re building a digital health company, it is especially important to develop a multi-faceted intellectual property protection strategy. Here’s why: a strategy that includes multiple pathways for IP protection allows you to protect both tangible assets, like proprietary hardware, software, and documentation, as well as intangible assets, like branding, customer-facing website designs, pricing strategies, business models and projections.
New Remote Therapeutic Monitoring CPT codes introduced in Proposed 2022 Medicare Physician Fee Schedule
On July 13th, the Centers for Medicare and Medicaid Services (“CMS”) released its proposed Medicare Physician Fee Schedule for Calendar Year 2022 (the “2022 Proposed MPFS” or the “Proposed Rule”). In doing so, it recognized five new CPT codes for Remote Therapeutic Monitoring (“RTM”) of “non-physiologic” patient data such as “musculoskeletal system status, respiratory system status, therapy (medication) adherence, and therapy (medication) response” as well as pain. While this new code set is welcomed by advocates for virtual care, the 2022 Proposed MPFS that discusses RTM may raise just as many questions as it answers.
Can Biotech and Pharma Companies pay contracted sales teams a commission-based fee?
The U.S. Department of Justice (DOJ) just sent a strong message to pharmaceutical and biotechnology companies who rely on contracted sales teams to push their products into the market: “commission-based compensation violates the Federal Anti-Kickback Statute (AKS)”.
This message seems to undermine years’ worth of relative stability in how these companies evaluate risks associated with commission-based compensation that does not fit squarely into a legal safe harbor under the AKS.
What is a Value-Based Enterprise? New Opportunities for Digital Health and Healthcare Innovation
Dramatic changes to the Anti-Kickback Statute and the Stark Physician Self-Referral Law regulations present an unprecedented opportunity for healthcare providers and digital health companies to create new business arrangements that align incentives around care coordination and patient engagement. Such arrangements are the foundation of the Value-Based Enterprise.
Discover how six important additions and amendments to the physician self-referral law ("Stark") could create opportunities to grow your healthcare business in 2021
A Final Rule published by CMS makes several important changes to the Stark Law that will be a boon for physicians eager to more closely coordinate with other providers to (1) better manage patient care and (2) to participate in the shift to value-based reimbursement.
Remote Patient Monitoring in the 2021 Medicare Physician Fee Schedule: The good, the bad, and the ugly
On December 1, 2020, the Centers for Medicare and Medicaid Services (“CMS”) released its Final Medicare Physician Fee Schedule for 2021 (the “Final 2021 MPFS”), revising payment policies for services provided to Medicare beneficiaries by medical practitioners. These policies will take effect on January 1, 2021. Read on for insights from Team NLG.
Pharmacy Innovation Series: Exploring Integration of Primary Care Services, Telehealth, and Telepharmacy for Pharmacies of all Sizes
Get our legal breakdown of the Walgreens/VillageMD partnership and how it relates to integration of primary care services, telehealth, and telepharmacy for pharmacies of all sizes. Subscribe to get the entire series.
Changes to the Anti-Kickback Regulations are Good News for Digital Health Innovation and the Shift to Value-Based Care
The Office of the Inspector General for HHS released a Final Rule aimed at reducing regulatory barriers and facilitating the move towards value-based care and giving healthcare providers and digital health companies more flexibility to enter into new business arrangements. This article is a high-level overview of the Rule and what it may mean for the future of healthcare.
Reimbursement for Virtual Check-ins and e-Visits in the Proposed 2021 Medicare Physician Fee Schedule
On August 3, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released it Proposed Medicare Physician Fee Schedule for CY 2021 (“Proposed MPFS”), seeking to expand reimbursement for Virtual Check-ins and e-Visits as a way of improving access to patient care. CMS proposes seven new HCPCS codes for these “Communication Technology-Based Services” that could be billed by practitioners who cannot bill Evaluation and Management (“E/M”) services independently.
Remote Patient Monitoring in the 2021 Proposed Medicare Physician Fee Schedule
Last evening, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed Medicare Physician Fee Schedule for CY 2021 (the “MPFS”). In addition to a number of important changes relating to the provision and reimbursement of telehealth, the proposed MPFS includes long-awaited clarifications around use of the Remote Patient Monitoring (“RPM”) codes established over the past three years