CMS announces yet another “ACO Product” designed to “transform the health industry” by changing how healthcare is paid to find an alternative to the traditional fee-for-service system. Most of their previous experiments have been unsuccessful – only six out of more than...

A new government watchdog report offers more doubt about the effectiveness of a heavily criticized Medicare provider payment program. The Merit-based Incentive Payment System scores physicians and other providers based on quality and cost measures and uses those scores to adjust future Medicare paym...

Physicians are now being actively recruited by health plans to sign up for a new “Direct Contracting Entity (DCE)” model promoted by CMS as an alternative to “traditional” Medicare. There are three versions of this model, and a summary explanation of each is available via the CMS website in ...

The Federal definition of a medical group practice is found at 42 CFR §411.352, and was amended on December 2, 2020.  This definition is used when dealing with Stark and Anti-trust issues, and as such incorporates several “tests:” A group practice is a physician practice that meets th...

Outsourcing Billing Services is a common management decision for physician practices, and it is important to understand the pros and cons of outsourcing vs bringing inside the practice when evaluating this decision. First, “tipping point” for most medical practices for bringing billing i...