AICPA National Healthcare Industry Conference Healthcare Hardball Questions

November 17th, 2012 | Healthcare Reform | Medicare | Reasonable Comp | Regulatory Matters | Seminars & Publications

We had a question we could not answer definitively at yesterday’s Healthcare Hardball session concerning assignment of Medicare beneficiaries to an ACO when they do not have a Primary Care Physician. The answer is that if a beneficiary does not see a PCP, as defined in the regulations, CMS will then evaluate which specialist physicians the beneficiary sought primary care services from. Presumably, this would be based on CPT and ICD data.  Chapter 8 of my book on Healthcare Reform with Greg Anderson is devoted to ACOs.

Someone also had a question about the excise tax on Medical Devices and here is the link to the IRS web page that contains links to the various issuances on the ACA.,-Multimedia-and-Legal-Guidance

The issue of tax-exempt organizations participation in the Medicare Shared Savings Program (ACOs) also came up and I said I would post the link to the IRS position on same. Importantly, the IRS has in no way waived the general rules of 501(c)(3) for participation and the anti-inurement rules still apply – unlike the waivers from Stark, AKS and anti-trust issues provided by CMS and DOJ. As I indicated in my session on Valuation and Reasonable Compensaiton for tax purposes, there is a lack of focus on income tax issues due to the prevailing obsession with Stark and the AKS.

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