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Medicare Launches New Comprehensive Care for Joint Replacement Bundled Payment Model

As part of the new Alternative Payment Model (APM) intended to improve the patient experience, increase the population’s health, and reduce per capita costs for certain medical procedures, Medicare has launched the Comprehensive Care for Joint Replacement (CJR) Bundled Payment Model. The program went into effect in April 2016 and will continue for the next 5 years. The CJR is a bundled payment program that focuses on hospitals where joint...

CMS Announces New Comprehensive Primary Care Plus (CPC+) Payment Model for Primary Care Practices

The Centers for Medicare & Medicaid Services (CMS) recently announced Comprehensive Primary Care Plus (CPC+), the latest payment model for primary care practices. CPC+ is a multi-payor risk and incentive based payment model that makes notable changes to how primary care practices are paid in order to improve the quality of care and decrease excess healthcare utilization. Based on lessons learned from the Comprehensive Primary Care model, CMS claims this new...

What Providers Need to Know about MACRA’s Value-Based Tracks: Merit-based Incentive Payment Systems (MIPs) and Alternative Payment Models (APMs)

Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has been looking to find new and innovative ways to reimburse providers who provide care to Medicare beneficiaries. In April 2015, Medicare Access and CHIP Reauthorization Act (MACRA), a new and alternative payment method law that revamps fee-for-service payment, was signed in to law by President Obama. MACRA is proposed to change the way Medicare pays clinicians and...

Unwinding Hospital-Physician Acquisitions

This article was originally published in the April 2016 issue of New Jersey Lawyer, a publication of the New Jersey State Bar Association, and is reprinted here with permission. View PDF version of this article. When the Honeymoon Ends In the past several years, many hospitals have been in a feeding frenzy, purchasing one medical practice after the other. Primary-care physicians, cardiologists, OB/GYNs and other specialists have been the targets...

“Lack of Medical Necessity”: An Increasingly Utilized and Amorphous Enforcement Tool

This is the first in a series of articles. As Healthcare attorneys, we begin our day reading press releases from the U.S. Department of Justice (DOJ) and Office of Inspector General in the U.S. Department of Health and Human Services (OIG). These press releases tout recent prosecutions or guilt pleas achieved against  healthcare providers by Assistant United States Attorneys. These crack-of-dawn emails serve as a daily reminder of the immeasurable...