HBMA Washington Report – December Issue

Washington Report – December, 2016

(Covers activity between 12/1/16 and 11/31/16)

Bill Finerfrock, Matt Reiter, Nathan Baugh, Asad Karamally, Carolyn Bounds

Washington Report – December Issue

  • Quality Payment Program Begins (A Friendly Reminder)
  • Republicans to Make ACA Changes an Immediate Priority
  • CMS Will Not Finalize Medicare Part B Drug Reimbursement Proposal
  • HHS Updates Civil Monetary Penalties and Anti-Kickback Safe Harbors
  • GAO: Small and Rural Practices Face Challenges in Value-based Payment Models
  • National Healthcare Spending Increased by 5.8 Percent in 2015
  • CMS to Require Disclosure of Third Party Premium Payments by Dialysis Facilities
  • Reminding Providers to Revalidate
  • CMS Finalizes 2018 Health Insurance Exchange Rule
  • CMS Finalizes Bundled Payment Model for Hip and Femur Fractures
  • Program Transmittals

Ober | Kaler Health Law Special Alert

Final Rule Implements Quality Payment Program under MACRA

By: Kristin M. Bohl, Kristin Cilento Carter, Christopher P. Dean, and Matthew W. Horton

MACRA? SGR? QPP? PQRS? MIPS? APM? . . . Eligible clinicians?

If you are a physician, mid-level provider, or work with those providers, then you have been bombarded with new acronyms for new programs and promises to remove older acronyms from your Medicare vocabulary.

Medicare suppliers who bill and collect for physician services under the Medicare Physician Fee Schedule (PFS) will enter 2017 reacting to the final Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive rule [PDF] published on November 4, 2016 (Final Rule) which implements a significant portion of MIPS and Advanced Alternative Payment Models (called Advanced APMs) as part of CMS’s Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) [PDF].

Attorneys in Ober|Kaler’s Health Law Group have been reviewing CMS’s comments and regulations, consulting with experts and colleagues across the country, and, most importantly, listening to our clients voice their concerns about the changes to data reporting and reimbursement for professional services under the PFS.

This white paper is intended to serve as a springboard to understanding these initial changes, give meaning to the new alphabet soup of acronyms and put some context into the changes still to come. Many things will happen in 2017 that will affect providers’ future reimbursement. Older quality-minded programs will start to be replaced. Many health care providers will evolve in their administration and delivery of care. They will choose to make administrative, operational, and procedural changes to take advantage of the increased reimbursement under the new model – or simply to avoid the lower reimbursement that non-compliance will bring. Click to continue…


Ober|Kaler will be combining with the well-respected national law firm Baker Donelson as of January 1, 2017.

The combined firm will have the third largest health practice in the country and will rank among the 50 largest law firms in the country, with more than 800 attorneys and advisors across 25 offices in nine states as well as Washington, D.C.

“This combination will bring together two strong firms with national reputations, particularly in health care, financial services and construction, for exceptional client service. We were drawn to Baker Donelson’s outstanding reputation and the chance to offer our clients a significantly expanded platform with a broader reach, both geographically and in terms of the range of legal counsel that a firm of more than 800 attorneys and advisors brings.” — Ober|Kaler CEO S. Craig Holden

Learn more about the joining of Ober|Kaler with Baker Donelson.

About Ober|Kaler

Ober|Kaler is a national law firm that provides integrated regulatory, transaction and litigation services to financial, health care, construction and other business clients throughout the United States. The firm has more than 110 attorneys in offices in Baltimore, MD, Washington, DC and Falls Church, VA. For more information, visit www.ober.com.

To learn more about Ober|Kaler’s Health Law Group, visit www.oberhealthlaw.com.
This publication contains only a general overview of the matters discussed herein and should not be construed as providing legal advice.

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