Posts tagged Medicare
CMS Finalizes APCM Codes for 2025: What it Means for Primary Care and Digital Health Companies
CMS Finalizes APCM Codes for 2025: What it Means for Primary Care and Digital Health Companies

CMS has finalized the APCM codes for 2025. See what this means for primary care and digital health companies.

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Medicare Physician Fee ScheduleCarrie Nixonremote patient monitoring, Telehealth, Medicare, Teleheath, Digital Health, behavioral health integration, mpfs, medicare physician fee schedule, remote therapeutic monitoring, digital health, mental health, telemental health, DMHT, APCM, CMS, MPFS, codes
New Reimbursement Opportunities for Digital Mental Health Treatment in 2025: CMS’ Final Rule
New Reimbursement Opportunities for Digital Mental Health Treatment in 2025: CMS’ Final Rule

See what the final Medicare Physician Fee Schedule for 2025 has to say about Digital Mental Health Treatment

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Remote Monitoring, Medicare Physician Fee ScheduleCarrie Nixonremote patient monitoring, Remote Therapeutic Monitoring, Remote Monitoring, remote care, Telehealth, Medicare, Teleheath, Digital Health, behavioral health integration, mpfs, medicare physician fee schedule, remote therapeutic monitoring, digital health, mental health, telemental health, DMHT
OIG’s Call for Increased Oversight of Remote Patient Monitoring Misses the Mark
OIG’s Call for Increased Oversight of Remote Patient Monitoring Misses the Mark

Learn about the Office of Inspector General’s new report around remote patient monitoring and the key areas where it misses the mark.

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Remote MonitoringCarrie NixonOIG, remote patient monitoring, Remote Therapeutic Monitoring, Remote Monitoring, remote care, Telehealth, Medicare, Teleheath, software as a medical device, Digital Health, compliance, compliance assessment, Healthcare compliance, Chronic Care Management, Principal Care Management, behavioral health integration
Navigating Reimbursement Strategies in the Food as Medicine Space
Navigating Reimbursement Strategies in the Food as Medicine Space

One of the key factors in FaM’s growth is reimbursement policy across various payors and providers. This post introduces reimbursement frameworks and strategies that support the FaM space, including medical nutrition therapy (MNT), medically tailored meals (MTM), the Supplemental Nutrition Assistance Program (SNAP), and employer-sponsored benefits programs.

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Food As MedicineMichael Pappas and Samuel Pinsonfood as medicine, Healthcare innovation, reimbursement, medicaid, Medicare, Commercial payers
Telehealth in the 2022 Medicare Physician Fee Schedule: Audio-Only Telehealth for Mental Health Made Permanent, and CMS Punts on Remote Direct Supervision
Telehealth in the 2022 Medicare Physician Fee Schedule: Audio-Only Telehealth for Mental Health Made Permanent, and CMS Punts on Remote Direct Supervision

On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) finalized the Medicare Physician Fee Schedule for Calendar Year 2022 (the “Final 2022 MPFS” or the “Final Rule”). As we noted in our July article discussing the Proposed 2022 MPFS, CMS made some significant proposed changes to allow for audio-only telehealth in some limited circumstances. In addition, the agency also proposed to enable remote “direct supervision,” which would allow practitioners to supervise clinical staff billing incident to their services as long as they could be available by audio/video communication as necessary.

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Telehealth, Medicare Physician Fee ScheduleRebecca GwiltTelemedicine, telementalhealth, 2022 Medicare Physician Fee Schedule, 2022, MPFS, Medicare, telemedicine, CMS, 99441, 99442, 99443, CPT, 93797, 93798, G0422, G0423, G2252
Biden Administration Requires Vaccination for Medicare and Medicaid Certified Providers/Suppliers by January 2022: CMS Issues its Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule
Biden Administration Requires Vaccination for Medicare and Medicaid Certified Providers/Suppliers by January 2022: CMS Issues its Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule

The Centers for Medicare and Medicaid Services (CMS) issued its Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (IFR) on November 4, 2021, the same day the Department of Labor’s Occupational Safety and Health Administration (OSHA) issued its COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS). The IFR and ETS complement each other, with both aimed at furthering the Biden Administration’s goal of vaccinating the entire United States healthcare workforce to ensure capacity to serve local and national healthcare needs, the safety of the workforce and patients, and to reduce the risk of continued COVID-19 transmission. Both rules are effective November 5, 2021.

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Corporate Healthcare LawFaisal KhanCOVID-19, vaccine, medicaid, Medicare
Remote Patient Monitoring in the 2021 Medicare Physician Fee Schedule: The good, the bad, and the ugly
Remote Patient Monitoring in the 2021 Medicare Physician Fee Schedule: The good, the bad, and the ugly

On December 1, 2020, the Centers for Medicare and Medicaid Services (“CMS”) released its Final Medicare Physician Fee Schedule for 2021 (the “Final 2021 MPFS”), revising payment policies for services provided to Medicare beneficiaries by medical practitioners. These policies will take effect on January 1, 2021. Read on for insights from Team NGL.

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Remote Monitoring, Medicare Physician Fee ScheduleCarrie Nixon and Kaitlyn O'Connor2021 MPFS, Digital Health, Telehealth, Telemedicine, Remote Patient Monitoring, RPM, CMS, Medicare, regulations, 2021 Medicare Physician Fee Schedule, Carrie Nixon, Kaitlyn O'Connor
The Future of Telehealth is Now in Sight: CMS’ Proposed Changes to the Medicare Physician Fee Schedule for CY 2021
The Future of Telehealth is Now in Sight: CMS’ Proposed Changes to the Medicare Physician Fee Schedule for CY 2021

On Monday, August 3, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released the 2021 Medicare Physician Fee Schedule Proposed Rule (the “2021 Proposed Rule”). In the healthcare industry, the Medicare Physician Fee Schedule or “MPFS” is arguably the most prominent force shaping the industry on an ongoing basis. Each year, CMS releases a Proposed Rule mid-summer to give stakeholders a first look at what is potentially to come for the following year. Stakeholders have an opportunity to comment on those proposals, CMS reads the comments it receives, and then based on those comments CMS updates its proposals and releases a Final Rule.

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Telehealth, Care Management ServicesKaitlyn O'ConnorCMS, Teleheath, Medicare, Kaitlyn O'Connor
Carrie Nixon in Modern Healthcare Discussing the Senate Hearing on Telehealth
Carrie Nixon in Modern Healthcare Discussing the Senate Hearing on Telehealth

Nixon Law Group’s Managing Partner, Carrie Nixon, was quoted in an article appearing in Modern Healthcare discussing the Senate HELP Committee hearing on telehealth that took place on June 17, 2020. The article notes general consensus among Committee members on two areas set forth as priorities by the Committee’s Chair, including 1) making permanent the elimination of the originating site and geographic restrictions for Medicare reimbursement of telehealth visits; and 2) maintaining and potentially expanding the list of services that may be provided by telehealth under Medicare, along with the list of types of healthcare providers eligible to provide these services to Medicare beneficiaries.

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TelehealthCarrie NixonTelehealth, Telemedicine, COVID-19, Medicare, Carrie Nixon
CMS clarifies use of Remote Patient Monitoring during COVID-19 and further expands Telehealth for Physical Therapists, Occupational Therapists, Speech Pathologists, other practitioners
CMS clarifies use of Remote Patient Monitoring during COVID-19 and further expands Telehealth for Physical Therapists, Occupational Therapists, Speech Pathologists, other practitioners

The Center for Medicare and Medicaid Services (“CMS”) has issued a second Interim Final Rule (“IFR2”) that includes additional expansions and clarifications relating to the provision and reimbursement of telehealth, remote patient monitoring, and telephone services during the COVID-19 Public Health Emergency (“PHE”). While these expansions are another step forward for the adoption of digital technologies and services in healthcare, there are additional changes needed in the near-term, as detailed in the summary below.

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Telehealth, Care Management ServicesCarrie NixonTelehealth, Telemedicine, Remote Patient Monitoring, Remote Monitoring, COVID-19, Medicare, CMS, Reimbursement, Coronavirus, Carrie Nixon
How to make sure you get (and keep) your Medicare CARES Provider Relief Fund Payment
How to make sure you get (and keep) your Medicare CARES Provider Relief Fund Payment

Medical providers across the spectrum have endured a significant hit to revenues as a result of the COVID-19 public health emergency (PHE). MGMA’s recent report, “COVID-19 Financial Impoact on Medical Practices”, indicates that nearly 100% of providers have seen a negative revenue impact, with an average decrease in revenue of 55%. To offset some of those losses, the CARES Act allocated a $50 billion “general allocation” to support the sustainability of these providers.

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Corporate Healthcare Law, Care Management ServicesRebecca GwiltCoronavirus, COVID-19, Medicare, cares act
Proposed 2020 Medicare Physician Fee Schedule offers new reimbursement for Remote Patient Monitoring
Proposed 2020 Medicare Physician Fee Schedule offers new reimbursement for Remote Patient Monitoring

On July 29, 2019, the Center for Medicare and Medicaid Services (“CMS”) released its proposed rule for the 2020 Medicare Physician Fee Schedule (the “2020 MPFS”).

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Remote Monitoring, Medicare Physician Fee ScheduleCarrie NixonRemote Monitoring, Remote Patient Monitoring, Medicare, 2020 Medicare Physician Fee Schedule, physician practice, Physicians, Reimbursement, Coronavirus
New CMS Innovation Models: Primary Care First and Direct Contracting
New CMS Innovation Models: Primary Care First and Direct Contracting

In April, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced a new set of payment models meant to allow primary care providers deliver better care at a lower cost to their patients by removing unneccessary administrative and adjust payouts from procedures to outcomes.

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Care Management ServicesCarrie NixonHealthcare innovation, CMS, Medicare, medicaid, regulations