Category:

Health Insurance

MACRA 101: MIPS and the Advancing Care Information Category

Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017   This article will spell out the details for the Advancing Care Information (ACI) category of the Merit Based Incentive Payment System (MIPS).  This category accounts for 25% of a clinician’s overall composite score and is intended to replace the current Meaningful Use …
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MACRA 101: MIPS and the Resource Use Category

Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018   As previously discussed, MIPS will streamline Medicare’s current quality measures into one composite score from four reporting categories: Quality, Resource Use, Advancing Care Information, and Clinical Practice Improvement. This score will then be used to determine the reimbursement to a clinician based …
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MACRA 101: MIPS and the Quality Reporting Category

Christine Bulgozdi Associate Editor Loyola University Chicago School of Law, JD 2018   The Merit-based Incentive Payment System (“MIPS”) is one of the two different payment methods that MACRA will use for eligible clinicians. MIPS replaces the existing fee-for-service model and is expected to be the payment track that most clinicians take. Clinicians will be evaluated …
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Understanding Medicare Documentation Requirements

Brittany Tomkies Executive Editor Loyola University Chicago School of Law, JD 2017   With more than one billion claims processed annually by the Medicare Fee-For Service (FFS) Program for more than one million health care professionals, understanding and identifying common errors encountered by Medicare Administrative Contractors (MACs) and other contractors such as Recovery Auditors (RACs) …
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IRS Ruling Threatens Future of Commercial ACOs, Cost-Reducing Healthcare Providers

Connie Zhang Associate Editor Loyola University Chicago School of Law, JD 2018   Your healthcare may come from an accountable care organization, and you may not even know it. That could soon change now that the IRS has denied one commercial accountable care organization (ACO) the tax-exempt status granted to most nonprofit health care providers. …
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MACRA 101: Physician Fee Schedule Adjustments and the New Pick Your Pace Options

Alanna J. Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017   In this article, we will cover the anticipated reimbursement scheme for both MIPS and APMs, as well as briefly discuss two new reporting paths recently revealed to be available to clinicians in 2017. One of the most attractive pieces of the …
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CMS Issues Proposed Rule Addressing Multiple Fraud and Abuse Concerns

Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017   The Centers for Medicare and Medicaid Services (CMS) recently proposed a new rule in the Federal Register that addresses changes in Medicare payment policies. The proposed rule aims to inform providers of proper billing practices and prevent fraud and abuse.  This post …
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MACRA 101: A Series on MACRA

Alanna J. Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017   The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law by President Obama back in April 2015 and one year later, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated proposed rule.  This 962-page rule is …
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