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The Centers for Medicare & Medicaid Services made headlines last Friday with the official unveiling of a comprehensive new regulation that will introduce major changes in the way in which clinicians -- physicians, nurse practitioners, physician assistants and therapists -- are compensated under the Medicare program.

The regulation, measuring almost 2,400 pages long, is designed to implement bipartisan legislation, the Medicare Access and CHIP Reauthorization Act, passed by Congress and signed by President Obama just last year. Although the regulation will take years to roll out and its success has yet to be determined, it nevertheless represents one of the single biggest reforms in the 50-year history of the Medicare program.

What exactly will the regulation accomplish?

The regulation changes the way in which clinicians are compensated under Medicare, with the focus now shifting from providing piecemeal payments for services rendered to payments based on the overall quality and cost-effectiveness of services rendered.

This will be largely accomplished through the creation of two new payment tracks -- Alternative Payment Mode and Merit-Based Incentive Payment System -- that will launch in 2019.

What does the Alternative Payment Mode involve?

Under the Alternative Payment Mode track, clinicians are able to earn higher reimbursements from Medicare provided they are willing to learn new business methods. This includes embracing electronic medical records, reporting quality measures to the federal government, and accepting more of a financial risk and reward approach for performance.

It's anticipated that roughly 100,000 clinicians will take this route.

What does the Merit-Based Incentive Payment System?

Under the Merit-Based Incentive Payment System track, clinicians are able to earn more modest reimbursements from Medicare, and are subject to accountability metrics for efficiency, quality, self-improvement and use of electronic medical records.

It's anticipated that anywhere from 400,000 to 500,000 clinicians will take this route.

Will certain clinicians be exempt?

The CMS is estimating that close to 380,000 clinicians will be exempt from the new regulation owing to the fact that their billings do not cross a designated threshold or they don't see enough Medicare patients.

What's been the response to the new regulation?

While it remains to be seen how the regulation will be embraced by the medical community, advocates are arguing that it will help keep healthcare costs in check and improve the overall quality of care. Critics, however, have argued that it could prove needlessly complex, and force both solo practitioners and small practices to join larger health groups.

Stay tuned for updates …

If you would like to learn more about your rights and obligations as they relate to Medicare or other compliance-related issues, consider consulting with a skilled legal professional.

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