StatLaw – September 2016

CMS  Announces MACRA Refinements: Although final regulations have yet to be promulgated under the Medicare Access and CHIP Reauthorization Act (“MACRA”), and are not scheduled to be issued until November, 2016, in a recent blog post, Andrew Slavitt, the Acting Administrator of the Centers for Medicare and Medicaid Services (“CMS”), announced options which physicians could […]

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Medicare Access and CHIP Reauthorization Act of 2015: The Future of Medicare Reimbursement – The Merit-Based Incentive Payment System

 When the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) goes into effect, most participating physicians will fall under the Merit-Based Incentive Payment System (“MIPS”).  MIPS was originally scheduled to go into effect on January 1, 2019, but its first “performance period” was to begin on January 1, 2017, as assessments in 2019 were […]

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Medicare Access and CHIP Reauthorization Act of 2015:The Future of Medicare Reimbursement – An Introduction

On April 16, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) into law.  This law will radically alter the manner in which physicians will be compensated for providing treatment and services to Medicare patients.  The good news is that the statute repealed the heavily criticized Sustainable Growth Rate (“SGR”) […]

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Medicare Access and CHIP Reauthorization Act of 2015: The Future of Medicare Reimbursement – The Alternative Payment Models

When the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) goes into effect, some participating physicians will be eligible for the Alternative Payment Models (“APM”).  Under MACRA, a physician who participates in an eligible APM will qualify for incentive payments through that program and be exempt from the Merit-Based Incentive Payment System (“MIPS;” discussed […]

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StatLaw – August 2016

MACRA Model Forcing Physicians to Evaluate Risk: Practices are now in the process of deciding which of the two possible reimbursement paths they will take under the Medicare Access and CHIP Reauthorization Act (MACRA). The shift from the much maligned sustainable growth rate formula (SGR) to MACRA is forcing physicians to think about issues typically […]

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Understanding the Process of Selling a Medical Practice

By Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq. Email Mathew Email Stacey There are many reasons physicians make the choice to sell their practice.  Increasingly, physicians are making the choice to sell their practice to a large group or hospital and entering into employment agreements with the particular purchaser, perhaps seeking a change […]

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Understanding Retrospective Audits and How to Avoid Them

By Mathew J. Levy, Esq.Email Mathew There is perhaps no more frustrating moment in a physician’s career than when a health plan or managed care company notifies him/her that, after the physician has spent countless hours and expended endless efforts to get paid fifty or sixty cents on the dollar for services rendered to his/her […]

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OPMC Reporter – Summer 2016

Family Doctor Volume 5, Issue 3 PHYSICIAN DISCIPLINED FOR PRESCRIBING TO FAMILY AND STAFF WITHOUT ESTABLISHING PHYSICIAN-PATIENT RELATIONSHIP OR MEDICAL NECESSITY A physician agreed not to contest the charge that he was disciplined by the Connecticut Medical Examining Board based on inappropriate prescribing practices for prescribing injectable Dilaudid to a relative and staff member. The Board […]

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SBME Reporter – Summer 2016

Painful Delivery? Volume 5, Issue 3 PHYSICIAN’S LICENSE SUMMARILY SUSPENDED FOR FAILURE TO DOCUMENT POTENTIALLY LIFE-THREATENING COMPLICATION In an Order Granting Partial Summary Decision and Suspending Licensure dated June 17, 2016, a respondent physician’s license was summarily suspended for three years, with the first two years to be served as a period of active suspension and […]

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StatLaw – July 2016

CMS Warns of Possible Delay of MACRA Implementation. On July 13, CMS Acting Administrator Andy Slavitt and senators showed that they have heard and understand the calls to slow down plans for implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Slavitt said he knows small physician practices might not have enough time to prepare […]

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Considering Going Out of Network in New York? Food For Thought

As insurance companies continue efforts to reduce reimbursement rates and increase administrative burdens on their participating providers, more and more physicians are considering terminating their in-network contracts with private insurance payors and going out-of-network.  If you or your practice are contemplating doing so, here are some issues you may want to consider when making that […]

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StatLaw – June 2016

Emergency Room Physicians Sue the Department of Health & Human Services (“HHS”) over Out-of-Network Payments: The American College of Emergency Physicians (“ACEP”) recently filed a federal lawsuit against the HHS, claiming a provision of the Affordable Care Act (“ACA”) allows insurers to underpay for out-of-network emergency medical services. Under the ACA, insurers must pay the […]

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SBME Reporter – Spring 2016

The Party’s Over Volume 5, Issue 2 PHYSICIAN’S LICENSE REVOKED FOR CDS POSSESSION, ILLEGAL TRANSPORTATION OF CDS, UNAUTHORIZED PRACTICE AND ABANDONMENT OF PATIENT RECORDS In a Final Consent Order dated February 25, 2016, a physician’s voluntary surrender of his license was deemed to be a permanent revocation. The physician agreed to the facts alleged against […]

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StatLaw – May 2016

UnitedHealth to Drop Out of Most Affordable Care Act Exchanges: In mid-April, UnitedHealth CEO Stephen Hemsley announced the company would pull out of most of its ACA marketplaces. However, the company will not withdraw from all the exchanges, and will continue to sell individual plans in what Mr. Hemsley said would be a “handful” of […]

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OPMC Reporter – Spring 2016

Doctor….No! Volume 5, Issue 2 LICENSE SUSPENSION OF AT LEAST SIX (6) MONTHS AND BOARD ORDERED COMPETENCY EXAMINATION AFTER HEARING COMMITTEE SUSTAINED CHARGES FINDING THE PHYSICIAN GUILTY OF GROSS NEGLIGENCE AND NEGLIGENCE ON MULTIPLE OCCASIONS A physician was charged with eighteen (18) counts of professional misconduct, including five (5) instances of gross negligence.  The panel was […]

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