Attached is a link to the fact sheet for “proposed policy, payment, and quality provisions changes to Medicare physician fee schedule for calendar year 2021”. Among other things, Centers for Medicare & Medicaid Services (CMS) proposes to: Significantly decrease the Medicare Work Relative Value Unit (WRVU) conversion factor from $36.09 to $32.26 Significantly revise the WRVU waiting and coding guidelines for popular E&M Codes 99211-99215 Significant WRVU decreases for radiology, CRNAs and chiropractors Additional telehealth…

Centers for Medicare & Medicaid Services (CMS) published the new hospital outpatient and ambulatory surgical center fee schedule for 2021 on August 12, 2020 at this this link:  https://www.federalregister.gov/documents/2020/08/12/2020-17086/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment As part of the proposed revisions, CMS intends to transfer over 1,500 procedures from the “inpatient only” category, including 266 musculo-skeletal procedures as of 2021, the explanation and list of which begins on page 386 in the attached link. For additional information contact Mike Cassidy.…

Mike Cassidy’s article, “Return to practice under the COVID threat” appears in the Bulletin of the Allegheny County Medical Society June edition.…

On June 23, 2020, the United States District Court for the District of Columbia denied the American Hospital Association’s (AHA) summary judgment motion claiming the Trump Administration had exceeded its authority and violated the First Amendment when it issued a new rule requiring greater price transparency. The Opinion is attached in the link below.  It begins by stating “the impenetrability of hospital bills is legendary”, “arcane”, and “mystifying”. By way of background, the Affordable Care…

This is a link to the update of the OIG Work Plan that you will see it includes several new entries regarding COVID issues at nursing homes: Meeting the challenges presented by COVID Audit of nursing homes reporting of COVID-19 information Nursing home oversight during COVID-19.…

The COVID pandemic has illuminated the need to modernize professional licensing.  Although professional licensing has always been a necessary vigilance with licensing has always been appropriate, and never more so than as highlighted by the opioid epidemic and telemedicine fraud schemes when physicians could issue prescriptions and orders for services over the internet for patients with whom they had no meaningful professional contact, there is obviously new interest in this area.  State licensing boards were…