CMS, ONC, MIPS, APMs, PI (MU?), Cures. Untangling the alphabet soup of healthcare and technology. 

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Healthcare providers and health IT developers alike face unique challenges presented by the intersection of physician payment reform and healthcare technology. From its inception, the Office of the National Coordinator’s (ONC) Heath IT Certification Program and CMS programs like the EHR Incentive Program and Promoting Interoperability (formerly Meaningful Use) have befuddled providers and health IT developers. Since the passage of Medicare and CHIP Reauthorization Act of 2015 (MACRA), the Merit-based Incentive Payment System (“MIPS”) and Alternative Payment Models (APMs) have continued that trend.  
 

And the acronyms and opportunities only go on from there, from Patient-Centered Medical Home (PCMH), Accountable Care Organizations (ACOs), Medicare Shared Savings Program (MSSP), all the way to Comprehensive Primary Care Plus (CPC+) and Primary Care First (PCF). 
 

Concurrently, additions to the Medicare fee schedule continue to incentivize providers to use technology in innovative ways. For example, the Chronic Care Management service (CCM services) require the use of certified EHR technology (CEHRT) – but allow for compensation for remote patient check-ins. 
 

In the coming year, the compliance burden and legal threats to these organizations will continue to grow as ONC and CMS implement the 21st Century Cures Act. Both ONC and CMS have proposed rules that substantially raise the stakes for entities that appear to or actually engage in “information blocking,” otherwise put, engaging in any practice that interferes with the use, access, or exchange of electronic health information. And those stakes are clear: the statute authorizes up to $1,000,000 in fines per instance of information blocking for health IT developers, and healthcare providers face new potential Conditions of Participation or adjustments in various payment programs. 
 

The Law Office of David Heller is here to help untangle the requirements – and opportunities – associated with these programs. These services include: 

 

• Representation in disputes regarding health IT certification, product defects, and/or physician payment programs. 

• Drafting comment letters and advocacy in response to proposed rulemaking that impact your business. 

• Regulatory counsel that clarifies program and billing requirements associated with health IT certification and physician payment programs like MIPS. 

• Fraud, waste, and abuse risk analysis of practices under the False Claims Act (FCA). 

• Compliance program review and design. 

• Review and analysis of practices to assess the risk of information blocking allegations under the 21st Century Cures Act and the proposed CMS and ONC rules.