Payment Matters

May 13, 2016

Physician Payment: CMS Proposes Quality Payment Program, Advanced APMs, and Merit-Based Incentive Payment System

CMS published its 426 page proposed rule [PDF] on the Quality Payment Program (QPP) – the successor to oft-maligned Sustainable Growth Rate adjustment – on May 9, 2016.  The QPP will adjust physician and mid-level provider reimbursement based on their quality of care and combine existing quality reporting programs into one system.  As we explained in our prior updates here and here, physicians, mid-level providers, and their practice groups will need to understand QPP and its two tracks, the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), because they will impact the reimbursement for professional medical services. Comments are due by June 27, 2016.

D.C. District Court Resolves Challenge to Medicare's Outlier Payment Rules for Banner Health v. Burwell

On March 31, 2016, Judge Colleen Kollar-Kotelly of the United States District Court for the District of Columbia (the “D.C. District Court”) issued a highly anticipated memorandum opinion [PDF] settling what will probably be the final issue regarding numerous hospitals’ challenges to Medicare outlier payments for fiscal years 1997-2007. The D.C. District Court ultimately granted summary judgment in favor of the Secretary of the U.S. Department of Health and Human Services (the “Secretary”).