Reasons for the Recommendation and Responses On March 15, 2023, the Medicare Payment Advisory Commission (MedPAC) published its annual Report to Congress regarding the status of the Medicare program. Among other areas, the report detailed policy recommendations for the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Pa ...

Center for Medicare & Medicaid Publishes Proposed and Final Rules on Medical Reimbursement Rates The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on physician reimbursement. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as a benchmark for p ...

Regulatory (Part IV of V) As noted in the first installment of this five-part series, an ambulatory surgery center (ASC) is a distinct entity that primarily provides outpatient surgical procedures to patients who do not require an overnight stay after the procedure. ASCs typically provide relatively uncomplicated surgical procedures in a non-hospital, outpatient setting, and most ASC cases are non-emergency ...

Reimbursement (Part III of V) As noted in the first installment of this five-part series, an ambulatory surgery center (ASC) is a distinct entity that primarily provides outpatient surgical procedures to patients who do not require an overnight stay after the procedure. The facilities typically provide relatively uncomplicated surgical procedures in a non-hospital, outpatient setting, and most ASC cases are ...

Introduction (Part I of V) Ambulatory surgery centers (ASC) grew dramatically until 2008 and during the growth period provided services previously only available at hospitals. In this five-part series, the authors first discuss the emergence and decline of ASCs, the forces driving growth and contraction, and how the ASC business model differs from that of hospitals. The remaining articles in this series dis ...

Planning their daily routine in retirement could be less complicated than most clients think, writes a Wall Street Journal columnist. In fact, most of what they will do as retirees are found in their current daily chores. "[T]he average day in retirement involves a fair amount of puttering," which "typically doesn't cost a lot of money," the columnist writes. It is good news for clients who are worried abou ...

Reimbursement Environment (Part III of V) The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on healthcare reimbursement. In 2017, Medicare and Medicaid accounted for an estimated $705.9 billion and $581.9 billion in healthcare spending, respectively. The prevalence of these public payors in the healthcare marketplace often results in their a ...

Elder financial fraud happens "at an alarming rate" and is often perpetrated by relatives, said Ted Sarenski, CPA, PFS.  Protect against elder financial fraud by safeguarding assets, following scam alerts, and monitoring accounts. To read the full article in The Lifeline Blog, click: Don’t Get Ripped Off!  What You Need to Know About Elder Financial Fraud. ...

Many long-term investors have amassed substantial capital gains since the market bottomed out in March 2009.  While great-looking on paper, such gains have real tax implications for engaging in even routine investment adjustments. To read the full article in FinancialPlanning, click: Kitces: Three Strategies for Managing Big Capital Gains. ...

The key to implementing this suggested strategy is establishing auto-IRA plans to workers who lack a 401(k) option with a preset percentage of wages to be contributed to the plan.  This would create a retirement nest egg that would not be linked to any one employer, but rather would stay with the worker throughout a career. To read the full article in FinancialPlanning, click: Could this Simple Social Secur ...

Since 2007, the Medicare Modernization Act of 2003 has required high-income Medicare enrollees to pay an Income-Related Monthly Adjustment Amount surcharge, or IRMAA, on their Medicare Part B premiums.  This lifts the premium from covering just 25% of costs up to as high as 80% of results, and increased Part B premiums by as much as 219% in 2017 alone. To read the full article in FinancialPlanning, click: T ...

Why Annual Medicare Coverage Reviews Benefit Clients Annual reviews can ensure clients who are Medicare beneficiaries have the coverage they need.  During the Medicare Open Enrollment period, which starts Oct. 15, clients can select different prescription drug coverage, move to a Medicare Advantage plan, or make other changes to their coverage.  PFP/PFS Section members can access over 100 ready-to-go, clien ...

When helping clients claim Social Security benefits, past planning strategies may act as the best guides.  Over the last several months, we published dozens of stories including insight from advisers and analysts on Social Security planning tips and strategies.  Some of these include insight related to long-term funding issues, clients working abroad, evaluating the impact of taxes as well as tips for deali ...

Some American workers are worried about their financial security in retirement, according to a Transamerica survey.  In this article, Todd Campbell looks at five common fears involving retirement and how they can be addressed. To read the full article in The Motley Fool, click: How to Address Common Concerns About Retirement. ...

Why Clients Need to Discuss End-of-Life Care Baby boomers are at the forefront of the conversation around end-of-life planning, which should include discussing end-of-life treatments with family members and physicians, and designating health care proxies.  Elizabeth O’Brien, retirement reporter, also suggests reviewing elder planning tools and resources, which includes a free consumer End of Life Guide. To ...

The Impact on Employed Physician Groups The CMS 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System downwardly revised reimbursement for GI/endoscopy services and reduced by 0.77 percent the Physician Fee Schedule to all services because CMS failed to meet the one percent net reduction target for misvalued codes in 2016. In this article, the author discusses how ...

In this second part of a two-part series, the authors discuss why and when the highest and best use standard should apply. ...

Traditional valuation methodologies have relied upon the analysis of historical accounting and other data as predictive of future performance and value. However, this may not hold true with every economy, industry, or even every enterprise within an industry, over time. For example, the turbulent status of the healthcare industry over the last five decades, since the passage of Medicare in the 1960s, has in ...

Compensation for PCPs is increasing The increasing supply shortage of primary care physicians (PCPs) will have a significant impact on physician compensation. In turn; this will have an equally powerful effect on the valuation of PCP practices. ...

Four things valuators should know about medical claims and coding In this second installment of his review of medical claims coding, Mr. Moffatt sets forth his final two examples that explain the unique circumstances of the medical practice revenue cycle that affect cash flow and how they relate to the valuation of a medical practice. Part 1 of this article was published on March 4, 2014. ...