Making Sense of the Ever-Changing Medicare Physician Fee Schedule

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by Karin Chernoff Kaplan, Director,
and Richard Chasinoff, Principal
and Jack Lacy, Senior Associate

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By now you’ve probably read (whether published by Veralon or another source) that there were significant changes made to the 2021 Medicare physician fee schedule (PFS). The entire program was originally intended to be budget neutral, but reimbursement was restructured to increase payments to cognitive specialties (such as primary care and other medical specialties) and […]

Posted in Provider Compensation

5 Key Benefits of a Service Line Management Structure

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by Lynda Mischel, Principal
and Meredith Inniger, Manager

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Often service lines are just a marketing tool, branding assorted practices as a specialty service line without connecting the services in a meaningful way. By establishing a management structure for service lines, hospitals and health systems can create an organized system of care for patients to progress smoothly from service to service. As health systems […]

Posted in Strategy & Planning

Special Fraud Alert: Speaker Programs

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by Karin Chernoff Kaplan, Director
and Monica Nuñez, Manager

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In November 2020, the Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert related to speaker programs sponsored by pharmaceutical and medical device companies. Specifically, the Alert centered on the OIG’s significant and longstanding concerns regarding fraud and abuse risks associated with remuneration for such programs. Speaker programs—events […]

Posted in Healthcare Valuation

Welcome News for Health Care Providers: It’s Not as Bad as You Thought – At Least for Now

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by Karin Chernoff Kaplan, Director
and Richard Chasinoff, Principal

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In the final days of 2020, Congress passed, and the President signed into law, the latest coronavirus relief package. This additional round of COVID relief legislation contains welcome news for health care providers: a one-time, one-year increase to physician fee schedule payments for 2021. The legislation creates a 3.75 percent increase in Medicare Physician Fee […]

Posted in Healthcare Valuation

Taking Virtual Meetings to the Next Level: 7 Tips for Facilitation

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by John Harris Director
and Meredith Inniger, Manager

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Are you deciding whether to hold a virtual retreat/meeting or to postpone until it can be in person? Virtual retreats can be very effective, preparing your organization for quicker action when the pandemic clears. Remote meetings will continue well into 2021, and maybe beyond as work models and meeting expectations shift. How can you effectively […]

Posted in Strategy & Planning

3 Questions Every System Should Answer Following the Medicare Hospital Outpatient Prospective and ASC Payment System Final Rule

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by Lynda Mischel, Principal
and Meredith Inniger, Manager

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One of the most impactful final rules released by CMS in recent months is the CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC). This rule includes several important policy changes, most notably the elimination of the Inpatient Only List on a phased schedule through CY2024 (when […]

Posted in Strategy & Planning

Radiation Oncology Alternative Payment Model: 3 Things to Do Now

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by Lynda Mischel, Principal
and Scott Stuecher, Manager

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CMS is launching a Radiation Oncology Alternative Payment Model (“RO Model”) that will profoundly affect radiation oncology economics, with a target start date of January 1, 2022. The RO Model will apply (or at least test) a bundled payment methodology affecting about 30% of eligible radiation oncology episodes. Revenue reductions may be as high as […]

Posted in Strategy & Planning