Archives: Accountable Care Organizations

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Managing MACRA – Part VII: What happens to MACRA if the Affordable Care Act is repealed?

Even without potential changes to the Medicare program, MACRA poses a significant challenge for any clinician trying to determine the best strategy to maximize Medicare reimbursement – there are hundreds of pages of guidance in the proposed and final regulations to review and understand. But, at this point, clinicians attempting to assess MACRA must also … Continue Reading

Managing MACRA – Part V: What do I have to do if I’m in an ACO?

As of January 2016, there were 433 Medicare Shared Savings Program (MMSP) Accountable Care Organizations (ACOs) with almost 7.7 million assigned beneficiaries and more than 14,000 participants (a participant may be a group or an individual). Most of these ACOs are one-sided model ACOs that may generate shared savings and do not involve shared losses (Track … Continue Reading

Managing MACRA – Part IV: When does it begin?

Under MACRA, the merit-based incentive payment system (MIPS) automatically applies to eligible clinicians (generally a physician or mid-level – see our previous blog post for details) and most clinicians who treat Medicare patients are expected to be included in MIPS. As a result, one of the most common questions about MACRA is when it starts. CMS’s … Continue Reading

OIG issues FY 2016 Work Plan with more than 40 new focal areas

The Office of the Inspector General (OIG) for the U.S. Department of Health & Human Services recently published its Fiscal Year 2016 Work Plan, which summarizes OIG’s priorities over the coming year. Notably, the 2016 Work Plan demonstrates the OIG’s expanded focus on delivery system reform and the effectiveness of alternate payment models, coordinated care … Continue Reading

Still no word from DOL on changes to FLSA regulations

The DOL’s self-imposed February deadline for announcing new FLSA regulations redefining “white collar” exemptions has come and gone with without any action from the DOL. No new deadline has been announced; however, the DOL’s website suggests that it still hopes to release the new regulations soon. Stayed tuned, and we will report back when the … Continue Reading

Changes coming to FLSA regulations – Time to get ready

In March 2014, President Obama directed the Secretary of Labor to prepare and propose new FLSA regulations. These new rules were to be announced late last year, but have been repeatedly delayed. Now it appears the new rules will be announced later this month. While the scope of the changes is unknown, it is anticipated … Continue Reading

HHS makes moves toward value-based payments

On Jan. 26, 2015, Secretary Sylvia M. Burwell announced the goals and a timeline of the U. S. Department of Health & Human Services (“HHS”) to move the Medicare program, and the healthcare system at large, toward paying providers based on quality, rather than quantity, of care they give to patients.… Continue Reading

CMS Promotes Coordination to Reduce Readmissions

CMS continues to emphasize readmissions as a marker of quality.  CMS research shows that approximately 45% of hospital admissions among those receiving either Medicare skilled nursing services or Medicaid skilled nursing services could have been avoided.  Husch Blackwell attorneys Mark Chouteau and Michael Crowe recently authored an article in the October issue of AHLA Connections … Continue Reading

Provider Alliances: Trend or True Benefit?

In response to healthcare reform, terms such as “physician alignment strategies” and “physician integration” have resurfaced in our vocabulary as healthcare providers.  In our new healthcare environment, many experts advocate that only hospitals that are aligned, or integrated, with their physician providers will be able to organize delivery systems that are capable of meeting current … Continue Reading

How Does the Supreme Court’s Recent Decision Impact Employers and Employer-Sponsored Health Plans?

In the wake of the U.S. Supreme Court’s June 28, 2012, decision upholding the constitutionality of the 2010 Patient Protection and Affordable Care Act, employers who had been awaiting the decision should now focus on compliance. We expect additional guidance will be released to implement several pending provisions, including those related to the 2014 employer responsibility … Continue Reading

How Do You Evaluate and Address the Compliance Risks Associated with ACOs and Other Physician Alignment Models?

On July 10, 2012, two members of the Husch Blackwell Healthcare Group, Kate Mihalevich and Cori Turner, presented a webinar on ACO strategic physician alignment billing compliance.  The webinar: highlighted compliance risks associated with ACOs and other physician alignment models; and provided practical suggestions for evaluating and addressing risk in these areas. To watch a … Continue Reading
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