Overview


Sheila advises clients on a wide variety of Medicare payment and regulatory issues. With more than 10 years of experience, Sheila is highly skilled in the areas of Medicare physician and hospital outpatient payment, Medicare quality programs, and the establishment and valuation of CPT® codes. Sheila has a deep understanding of emerging technology’s impact on Medicare reimbursement. She has facilitated relationships and discussions with physician specialty societies and industry stakeholders, helping to develop mutually beneficial collaborations. Sheila also has guided clients on working with the U.S. Centers for Medicare and Medicaid Services (CMS), and steered them through the American Medical Association’s CPT® Editorial Panel and RVS Update Committee (RUC) processes.

Prior to joining McDermottPlus, Sheila worked on behalf of physician specialty societies, trade associations and medical technology companies, serving as lead staff on Medicare reimbursement and coding issues.

Education


  • Johns Hopkins University, Bloomberg School of Public Health, M.P.H., 2006
  • University of Chicago School of Social Service Administration, M.A., 1997
  • University of Chicago, B.A., 1993

Representative Experience


Analyze Proposed and Final Rule changes concerning Medicare payment and policies (e.g., Medicare Physician Fee Schedule, Outpatient Prospective Payment System, Ambulatory Surgery Center fee schedule) and publicly available Medicare data (including payment, cost, and utilization data) to evaluate, develop and implement client strategies.

Facilitate relationships between providers, industry and payors.

Manage client participation in the American Medical Association CPT® Editorial Panel and RVS Update Committee processes from submission of code application to physician work and practice expense recommendation development.

Develop and conduct Medicare training for clients, including technology companies and trade associations.

Publications


“Radiation Oncology: A Perspective on Health Reform and Value Based Initiatives”, Journal of Oncology Practice, June 2014 (co-author)

“Gastroenterologists’ Experience with the 2007 Physician Quality Reporting Initiative”, Gastrointestinal Endoscopy (GIE), March 2009 (co-author)

“GI Experience with the Physicians Quality Reporting Initiative (PQRI): A Demonstration Project”, Poster Presentation at Digestive Diseases Week (DDW) 2008, July 2008 (co-author)

“Innovative Programs for Children 0-3 at Safety Net Institutions” (co-author) Commonwealth Fund; September 1999

Insights and In the News


UPDATED: CMS Finalizes 10% Payment Cut, Expands Telehealth Services in 2021 Physician Fee Schedule

CMS Releases CY 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment ...

Health Policy Breakroom Ep. 51 - 2021 PFS and OPPS Final Rules

Summary of Key Health Provisions in the Consolidated Appropriations Act, 2021

CMS Updates 2021 Physician CF to $34.8931, a 3.3% Reduction from the 2020 CF

The First 100 Days: Biden's Healthcare Outlook

PRF Update: HHS Increased and Distributed Phase 3 COVID-19 Provider Relief Funds

CMS Updates Coding and Billing Guidance for the COVID-19 Vaccine

COVID-19 Activities and Actions Update

CMS Solicits Comments on IRF Claims Demonstration Project

CMS Releases Proposed Rule on Prior Authorization Standards and Processes

US Healthcare Spending Grew by 4.6% in 2019

President-Elect Biden Announced Healthcare Personnel

Physician and Hospital Review of Open Payments Deadline is December 31

CMS Seeks Comments on Cost and Patient Reported Outcome Measures

CMS Updates QPP Resources

COVID-19 Relief Legislation Offsets Portion of Physician Payment Cuts and Provides Other ...

COVID-19 Activities and Actions Update

CMS Launches Annual Quality Measure Review Process

CMS Hosting Promoting Interoperability Webinar on January 12

CMS Publishes 2018 Update to Medicare Current Beneficiary Survey Chartbook

Call for Nominations: Outpatient Measure TEPs

Hospital Price Transparency Requirements Effective as of January 1, Despite Delay Attempts

MIPS 2020 Data Submission Portal Open

CMS Updates QPP Resources

CMS Releases Pandemic Plan

PHE Extended

COVID-19 Activities and Actions Update

CMS Finalizes Definition of “Reasonable and Necessary” and Policy Coverage on Emerging ...

CMS Hosts APP Webinar on Jan 21

CMS Updates QPP Resources

CMS Outlines Accomplishments During the Trump Administration

Sheila Madhani

Insights & Events / Media

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