Category Archives: Accountable Care Organizations

The Physician Board Member – Meeting Your Responsibilities as a Director

Understanding Legal, Ethical, and Practical Obligations for Healthcare Leaders Serving as a board member gives physicians a meaningful opportunity to shape the strategic direction of healthcare organizations and support their long-term success. The role also carries legal and ethical obligations … Continue reading

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Physician Autonomy in the Value-Based Care Era: Legal and Operational Priorities for Health Care Providers

Topics: value-based care compliance, physician autonomy, health care provider legal issues, Stark Law compliance, Anti-Kickback Statute compliance, physician compensation arrangements, value-based care contracts, health care compliance counsel, medical staff governance, accountable care organizations, provider reimbursement strategy, health care fraud and … Continue reading

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ACO Primary Care Exclusivity Requirement – Not As Broad As Some Believe

By John Fisher, JD, CHC, CCEP Client Alert – MSSP ACO Participant Exclusivity Remains Narrow and Assignment-Based Updated July 10, 2026 Bottom line: MSSP exclusivity remains narrow and assignment-based. Organizations should focus compliance efforts on the TINs and claims that … Continue reading

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Applying Section 1557 Discrimination Rules to Employer Sponsored Health Plans

By Fisher, JD, CHC, CCEP Section 1557 Final Rule: Implications for Covered Entities and Employer-Sponsored Health Plans April 2024 Executive Summary The U.S. Department of Health and Human Services (“HHS”) finalized regulations implementing Section 1557 of the Affordable Care Act … Continue reading

Posted in Accountable Care Organizations, Compliance Issues, Health Care Legislation, HIPAA - Health Information Privacy, Reimbursement Issues, Uncategorized | Comments Off on Applying Section 1557 Discrimination Rules to Employer Sponsored Health Plans

CMS Releases Final Rules Under Medicare Shared Savings Program

By Fisher, JD, CHC, CCEP MSSP Final Rules Revision ACO Requirements Under Shared Savings Program – 2016 Revised MSSP Regulations Issues On June 10, just in time for my birthday (thanks CMS), the Centers for Medicare & Medicaid Services (CMS) … Continue reading

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Bundled Payment Arrangements for Clinically Integrated Networks

By John Fisher, JD, CHC, CCEP Bundled Payment and ACO Arrangements – Clinically Integrated Payment Methodologies Overview of Bundled Payment Bundled payment represents a significant shift in healthcare reimbursement models, aiming to improve efficiency and quality while controlling costs. Under … Continue reading

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Health Care Compliance Resource Portal Launched by OIG

By Fisher, JD, CHC, CCEP Office Inspector General Launches New Compliance Resource Portal by John H. Fisher, II, JD, CHC, CCEP OIG Compliance Portal: Centralized Health Care Compliance Resources for Providers What the OIG Compliance Portal Adds At a recent … Continue reading

Posted in Accountable Care Organizations, Ambulatory Surgery Centers, Anesthesiologists, Compliance Issues, Consierge & Cash-Based Practices, Dental Practice, Dental Practice Issues, Fraud and Abuse, Health Law Practice, Home Health, Hospital Issues, Long Term Care, Medicare and Medicaid, Medicare and Medicaid Reimbursement, Physician Issues, Radiology Issues, Reimbursement & Payment Practices, Reimbursement Issues, Self Disclosure Protocols, Stark Law and Anti-Kickback Issues, Telemedicine | Comments Off on Health Care Compliance Resource Portal Launched by OIG

Population Health Management and Clinical Integration

By John Fisher, JD, CHC, CCEP Population Health Management and Clinical Integration June 13, 2016 Population Health Management and Clinical Integration: Structural Foundations of a Reformed Health Care Delivery System Abstract Population health management and clinical integration have emerged as … Continue reading

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Clinical Integration Readiness – Determining Organizational Readiness to Clinically Integration

Is Your Organization Ready to Build a Clinically Integrated Network? January 26, 2016 Start with the Right Readiness Assessment Clinically integrated networks can help health systems, hospitals, and physician organizations align around better care, stronger quality performance, and more efficient … Continue reading

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