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CMS Modernizing Medicare and Revitalizing the Doctor-Patient Relationship

On July 12, 2018, the Centers for Medicare and Medicaid Services (“CMS”) released a statement proposing significant changes to Medicare that would modernize and restructure the Medicare program to deliver increased quality of care at a lower cost to beneficiaries. This will be done by utilizing a value-based healthcare system that works with modern-day technology. The proposal primarily alters the Medicare Physician Fee Schedule and Quality Payment Program.

CMS’s proposal coincides with its Patients Over Paperwork initiative, because it reduces the paperwork requirements for billing, thereby enabling doctors to spend more time with their patients.  The proposed changes to the Physician Fee Schedule and Quality Payment Program will streamline documentation requirements to reduce the administrative burdens on providers. Generally, providers create medical records that use boiler plate language to satisfy Medicare billing requirements, which often contain few details specific to the patient and their personal stories. Allowing providers to designate a plan of care based upon what the provider determines from the time spent with the patient and not based upon documentation guidelines will significantly increase the quality of care.

If the proposal is effectuated, it will modernize payment policies so that telehealth will be more available to Medicare beneficiaries. When a beneficiary virtually contacts their provider (through telephone or other telecommunication devices) to determine whether they need and in-office visit or not, Medicare would cover this service. Additionally, there would be coverage for a physician’s time when they review images or videos sent to them for a diagnosis. CMS would also like to have a patient’s updated medical records follow the patient throughout the healthcare system. This would increase transparency and collaboration by allowing all of the patient’s providers to see the patient’s medical history in full.

CMS is slowing implementation of the Merit-based Incentive Payment System (“MIPS”) after 34 measures were deemed ineffective by stakeholders; however, 10 new measures have been introduced to MIPS. CMS will also allow Medicare Advantage plans to qualify as an alternative payment model through a demonstration called the Medicare Advantage Qualifying Payment Arrangement Incentive (“MAQI”). The MAQI demonstration is designed to test whether MIPS-eligible providers who participate to a sufficient degree in certain payment arrangements with Medicare Advantage Organizations (“MAOs”) may be exempted from the MIPS reporting requirements and payment adjustments and whether it will increase or maintain participation in payment arrangements and change the manner in which providers deliver care.

The CMS proposal will bring a lot of change to Medicare if it is implemented. Wachler & Associates will continue to stay up to date with changes to Medicare and other current healthcare topics.  If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at (248) 544-0888, or via email at You may also subscribe to our health law blog by adding your email at the top right of this page.

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