Archive for: Medicare

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Health Policy Breakroom: Episode 4, 2020 Changes to the Quality Payment Program

Mara McDermott and Sheila Madhani join Emma Zimmerman to discuss changes in the 2020 changes to the Quality Payment Program and the landscape of Advanced Alternative Payment Models.

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McDermottPlus Check-Up: December 06, 2019

Congress is back in town with just two weeks to address government funding and many healthcare issues. More proposals are emerging on drug pricing and surprise billing, and the House Judiciary Committee took up impeachment.

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McDermottPlus Check-Up: November 22, 2019

Impeachment continued to dominate the news, Congress averted a government shutdown, and federal vaping regulation stalled.

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Health Policy Breakroom: Episode 2, OPPS Prior Auth

Mara McDermott and Jessica Roth join Emma Zimmerman to discuss changes in the 2020 Hospital Outpatient Prospective Payment System final rule related to prior authorization and the landscape of utilization management policy more broadly.

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McDermottPlus Check-Up: November 15, 2019

Government funding negotiations continued against the backdrop of impeachment, and the CMS issued new rules on provider price transparency and Medicaid supplemental payments.

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McDermottPlus Check-Up: November 8, 2019

There was little activity in Congress with the House in recess, but we saw several developments in the Medicaid space including new guidance from the CMS.

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CMS Releases CY 2020 Medicare OPPS and ASC Payment System Final Rule

On November 1, 2019, CMS released the CY 2020 Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment Systems effective for services on January 1, 2020.

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CMS Releases Final Rule for CY 2020 Physician Fee Schedule

On November 1, 2019, CMS released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, which includes changes related to Medicare physician payment and the Quality Payment Program effective for services on January 1, 2020.

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McDermottPlus Check-Up: November 1, 2019

This Week’s Dose: Drug pricing discussions continued in Congress. The full House and the Senate Health, Education, Labor, and Pensions (HELP) Committee advanced health bills.

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McDermottPlus Healthcare Preview: October 28, 2019

A House Vote on Prescription Drug Pricing Reforms Slips as We Approach a One Week Recess in the House.

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McDermottPlus Check-Up: October 25, 2019

The House Ways and Means Committee completed its markup of H.R. 3, but floor consideration was pushed until mid-November. Seema Verma appeared before the House Energy and Commerce Oversight and Investigations Subcommittee.

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Overlapping Provisions in Major Healthcare Bills 2019

Lawmakers came with big ambitions for 2019, but we are headed into 2020 with two major health policies left on life support and many healthcare programs nearing expiration.

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Healthcare Extenders: What’s on the Table for 2019

There are 20 scheduled joint legislative days left until the current continuing resolution funding the government ends on November 21, 2019, followed by an additional eight scheduled joint legislative days until the end of the year. These are significant dates for several important healthcare programs and their funding.

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McDermottPlus Check-Up: October 4, 2019

This Week’s Dose: The impeachment inquiry proceedings are still moving forward, despite the Congressional recess. Surprise billing activity continued, and the Trump Administration issued an Executive Order on Medicare.

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The Overlap of Drug Pricing Proposals

On September 19, 2019, the Speaker of the US House of Representatives released a proposal to contain federal and individual spending on prescription drugs, joining Administration and Senate efforts to address prescription drug pricing. This article contemplates the likelihood of a drug pricing package and how it could come together.

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McDermottPlus Check-Up: August 2, 2019

This Week’s Dose: Things have quieted down in Congress with the House out of session and the Senate wrapping up its last week before the August recess. But the agencies are still at work, so don’t totally check out just yet.

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McDermottPlus Check-Up: July 26, 2019

This Week’s Dose: The Senate Finance Committee finally released its drug pricing package and moved quickly to a markup. The bill passed out of committee, but work will continue before the full Senate votes. We’ll be watching closely as things develop.

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What’s Next for the House Surprise Billing Package?

There has been a surge of congressional activity relating to the various surprise billing proposals. What started out as an issue for a small Senate working group last year has turned into a major health priority for both parties in both chambers.

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McDermottPlus Check-Up: July 19, 2019

This Week’s Dose: The Energy and Commerce Committee held a marathon mark-up of 25 bills, including 10 health care related bills. The No Surprises Act received an amendment that adds arbitration to the payment dispute process. The House voted to repeal the Cadillac tax. And, we finally have a Congressional Budget Office (CBO) score for…

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McDermottPlus Check-Up: June 28, 2019

This Week’s Dose: Lots of movement in Congress ahead of the Fourth of July recess with the House and Senate both advancing a number of health care bills. President Trump also signed an executive order this week, continuing the Administration’s focus on health care transparency.

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CMS Releases Final Rule Aimed at Lowering Drug Prices and Reducing Out-of-Pocket Spending

Since mid-2018, the Centers for Medicare and Medicaid Services has been implementing sections of the American Patients First Blueprint, President Trump’s plan to lower drug prices and reduce patient out-of-pocket spending.

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McDermottPlus Check-Up: May 10, 2019

This Week’s Dose: Another busy week for prescription drug pricing. Two more hearings took place on the subject, and a handful of bills passed out of the House. Now we watch the Senate to see how it packages and advances prescription drug bills that have moved through the House.

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McDermottPlus Check-Up: April 26, 2019

This Week’s Dose: When Congress is away, the agencies will play. The Administration made some major announcements and dropped several new important rules this week, giving stakeholders plenty to talk about (and work on) while Congress is in recess.

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McDermottPlus Check-Up: April 12, 2019

This Week’s Dose: Drug pricing continues to be the focus in Congress with multiple hearings and markups on the subject. So far, lowering drug prices remains a rare area of consensus among lawmakers.

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McDermottPlus Check-Up: April 5, 2019

This Week’s Dose: Health care continues to dominate much of the attention on Capitol Hill. Lots of hearings. New coverage expansion legislation. And more state action on Medicaid.

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Analyzing the President’s FY 2020 Budget: Key HHS Proposals

On March 11, 2019, the White House released its FY 2020 budget proposal. In the area of health care, the president has requested $87.1 billion in discretionary budget authority for HHS, which represents a 12 percent decrease from the 2019 estimated level. Read on for key HHS proposal highlights.

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McDermottPlus Check-Up: February 15, 2019

This Week’s Diagnosis: Congress passed a $328 billion spending package to avert another government shutdown.  President Trump is expected to sign it.  Congressional hearings continue to focus on coverage and drug pricing.  

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McDermottPlus Check-Up: February 1, 2019

This Week’s Diagnosis: Government reopens…for at least three weeks. Congress is full steam ahead, kicking off the 116th with health care hearings on drug pricing and pre-existing conditions. The US Department of Health and Human Services focuses on 2019 priorities.

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MSSP Final Rule Seeks to Accelerate Move to Performance-Based Risk in Traditional Medicare

On December 31, 2018 CMS published the Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 final rule.

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McDermottPlus Check-Up: November 16, 2018

This Week’s Diagnosis: Newly elected congressional members were welcomed to Washington this week, while currently serving members returned for a brief, but important post-election lame duck session.

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Top 10 Takeaways: 2019 Medicare Physician Fee Schedule

On November 1, 2018, the Centers for Medicare & Medicaid Services released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B [CMS-1693F] Final Rule, which includes policies related to Medicare physician payment and the Quality Payment Program (QPP). The regulations will be published in the…

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McDermottPlus Check-Up: September 28, 2018

This Week’s Diagnosis: Consideration of the Kavanaugh nomination dominated airtime in the Senate this week, but the House stayed on-task, pushing through a number of health-related bills.

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McDermottPlus Check-up: September 14, 2018

McDermott+Consulting is pleased to introduce the McDermottPlus Check-up, your regular update on healthcare policy from Washington, D.C.

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CMS Finalizes Next Implementation Phase of Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services

Beginning January 1, 2020, when submitting claims to Medicare for advanced diagnostic imaging services furnishing professionals and entities must certify that professionals ordering services consulted AUC applicable to the imaging modality

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New McDermottPlus Tool Replicates Practice Expense RVU Calculation

McDermottPlus’ PERVU Calculator replicates and verifies PERVUs published by CMS, which allows McDermottPlus to simulate the impact of alternate inputs on PERVUs and to assist with the development of comments in response to Proposed and Final MPFS Rulemaking.

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MedPAC June 2018 Report Focuses on Emergency Department Access and Use

On June 15, 2018, the Medicare Payment Advisory Commission (MedPAC) issued its June 2018 Report to the Congress: Medicare and the Health Care Delivery System.

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