Michigan Selected as a Market for CMS Primary Care Payment Initiative

The Centers for Medicare & Medicaid Services (CMS) recently announced the 10 states chosen for its Comprehensive Primary Care Plus (CPC+) initiative.  Michigan has been chosen for statewide participation.  In addition to Michigan, the following states were selected on either a state-wide or regional basis:  Arkansas, Colorado, Hawaii, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee. CMS will enter into a Memorandum of Understanding with selected third party payors in these states. Payment for services to primary care doctors… Read More >

What are MIPS Scores and Why Should Physicians Care?

The Merit-Based Incentive Program (MIPS) is as program established as a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  A proposed rule addressing the MIPS program was released on April 25, 2016 and is scheduled to be published in the Federal Register on May 9, 2016. The MIPS Program will apply to physicians as well as other Medicare Part B clinicians, such as physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.  MIPS… Read More >

Ohio Court Upholds Arbitration of Qui Tam Claims

The U.S. District Court for the Southern District of Ohio, Western Division, in the case of U.S. v. ex rel. Hicks v. Evercare Hospice recently granted a stay on certain qui tam claims pending arbitration. The Relators were registered nurses who worked for the Defendant hospice and alleged that the Defendants admitted patients without mandatory consent and/or power of attorney designations, billed for continuous care that was not reasonable or necessary and provided inadequate services to Medicare patients. The Relators… Read More >

Compensation for Advance Care Planning Services Proposed

The CY 2015 proposed physician fee schedule which will be published in the Federal Register on July 15, 2015, contains a proposal to include separate reimbursement for advance care planning, including the discussion of advance directives by physicians or other qualified health professionals. CPT Codes 99497 (first 30 minutes face-to-face advance care planning) and 99498 (additional 30 minutes) would be used to report the advance care planning services which could include the explanation and completion of standard forms. CMS noted… Read More >