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COMPLIANCE

CMS announces historic changes to physician self-referral regs

CMS has finalized changes to the Physician Self-Referral Law. The law prohibited physicians from making referrals to an entity, for certain health care services, if the physician had a financial relationship with the entity. The Centers for Medicare & Medicaid Services announced the changes to outdated federal regulations it says have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from sending a patient for many types of services to a provider that the physician owns, is employed by, or otherwise receives payment from—regardless of what that payment is for. The old federal regulations that interpret and implement this law were designed for a health care system… . . . read more.

WRVUs

The new paradigm for physician compensation: payment for value/quality v. volume

By John McDaniel bio How will physician compensation arrangements be impacted by quality incentive payments with respect to determining Fair Market Value and commercial reasonability? The enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) in November 2016 set forth future options for payment from Medicare, those being participation in the Merit‐Based Incentive Payment System (MIPS) or participation in one or more Alternative Payment Models (APMs). Both models will likely change how physicians are compensated. MIPS requires participating Medicare providers to be subject to payment adjustments, both positive or negative, based on their performance as determined by four measures, those being (1) quality, (2) advancing care information, (3) clinical practice improvement activities and (4) cost. While MIPS was designed to provide incentives for both quality and value improvements, it… . . . read more.

PUBLIC HEALTH EMERGENCY

OIG Temporarily Waives Anti-Kickback Restrictions for Certain COVID-19 Physician Arrangements

As it previously did with the Stark Law, the OIG is temporarily loosening Anti-kickback Statute (AKS) restrictions to clear the way for health care arrangements during the COVID-19 emergency that would be problematic in times of normalcy. Public Health Emergency (PHE) Waiver Rules During a PHE, the OIG has discretion not to impose penalties on remuneration arrangements that violate the AKS. On March 30, 2020, the OIG announced it was exercising that discretion by issuing what’s called Blanket Waivers for such arrangements. The message: Right now, delivering COVID-19 diagnosis and treatment is more important than the need to avoid arrangements offering remuneration in exchange for Medicare and other federal referrals. Things that labs may be allowed to offer, pay or provide referring physicians (and/or their immediate family members) during the… . . . read more.


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