Physician Reimbursement Reforms and New Delivery Models under Medicare

Why this Newsletter

We are sending this brief to provide you with practical ideas on how to use reimbursement data and payer decisions and policy to help you adjust your business plans and objectives.  We consider payer policy and data to be a source of high-quality market intelligence because it is timely, actual (not forecasted) and derived from reputable sources.

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Congress passed and the President Obama  signed federal legislation that will change how Medicare reimburses Physicians.  The legislation is referred to as the “Medicare Access and CHIP Reauthorization Act of 2015.”

Beginning the second half of 2015, Medicare physician payments will no longer be made under the Sustainable Growth Rate (SGR) formula.  Instead, the reimbursement amounts will be determined using two new models: The Enhanced Fee for Service and the Alternative Payment models.  Both models phase in a series of quality and pay-for-performance incentives for the physician when billing Medicare.  Thus, it is important to understand a key objective of the two new models is to accelerate Medicare’s shift towards value-based provider payments.

The Act did not address ICD-10 implementation, scheduled to take place on October 1, 2015.  As a result, we believe this materially increases the likelihood ICD-10 implementation will happen in the fall.  There have been legislated delays to ICD-10 conversion over the last few years.

We believe the passage of the Medicare Access and CHIP Reauthorization Act of 2015; the acceleration of value-based provider Medicare payments and the advent of ICD-10 offer business opportunities and implications for some of you reading this News Brief.  For more information contact Daniel Zimmerman d.zimmerman@suerowinskigroup.com

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About Rowinski Group

Founded in 2004, Rowinski Group LLC is a reimbursement and healthcare payer data analytics consulting firm for medical device, digital health, diagnostics, and imaging companies. Rowinski Group is based in Silicon Valley – San Francisco bay area with offices at selected client locations.

Rowinski Group has two core service offerings; securing codes and reimbursement on behalf of companies and applying healthcare payer data analytics to help solve companies’ complex business issues such as responding to questions from the FDA and U.S. Payers.

Through these service offerings Rowinski Group helps U.S. and international companies build their U.S. market share for the medical technology they are developing and selling. For more information visit www.rowinskigroup.com