Outsource Medical Billing

New Payment Models

The Centers for Medicare and Medicaid Services (CMS) has released an Interim Final Rule on March 21, 2017, which delays the effective date of many new Medicare payment models that were developed and introduced by the CMS Innovation Center, along with the introduction of updates to an existing model.

To be specific, the Interim Final Rule delays the January 3, 2017 Original Final Rule with the implications that are listed below.

  • Delay of effective dates of 3 episodic payment models until October 1, 2017. These models were designed to test the correctness of the episodic payments for some of the orthopedic and cardiac procedure and conditions.
  • Delay of the effective date of amendments to Comprehensive Care for Joint Replacement Model until October 1, 2017. This model is designed to test the correctness of bundled payment reimbursement methodology for care linked with knee and hip replacement.
  • Delay of the effective date of Cardiac Rehabilitation Incentive Payment Model until October 1, 2017. This model is designed to make providers in about ninety geographic locations to offer cardiac rehabilitation services through the implementation of retrospective incentive payment program.

The effective date of the Original Final Rule was previously delayed by a January 20, 2017 “Regulatory Freeze Pending Review” memorandum. This memorandum was from Reince Priebus, who is the Assistant to the President and Chief of Staff to the various heads of executive agencies and departments. The memorandum urged for a temporary postponement of those regulations that were published but have not taken effect yet, for reviewing the questions of law, fact, and policy.

Medical Billing Outsourcing

Interim Final Rule

CMS said in an explanation of the Interim Final Rule that the three months’ delay is required not only to support the participant capabilities and preparedness regarding the implementation, but also to offer necessary time to the agency to consider and undertake modifications if necessary. CMS is open to comments on the Interim Final Rule until April 19, 2017, and experts anticipate that this would be an active comment period for the stakeholders in the healthcare industry.

There are many concerns among the stakeholders in the healthcare sector that the Interim Final Rule is a signal that CMS is retreating from the value-based payment model. These are the reforms, that aimed at shifting the healthcare industry from the current fee-for-service model to mechanisms that are based on the care process, cost, and the quality of the outcomes.