CMA pushes top 10 priorities for Medicare/Medicaid regulatory relief California physicians are overwhelmed with unnecessary, burdensome regulations that take time and resources away from providing quality patient care. These regulations are a major contributing factor to the disturbing trend in physician burnout. The California Medical Association (CMA) submitted comprehensive comments urging the Centers for Medicare and Medicaid Services (CMS) to reduce the regulatory burdens under the Medicare and Medicaid programs. As part of the comment period for the proposed Medicare physician payment rule for 2018, CMS is soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles. CMA submitted its top 10 priorities for regulatory relief, which were developed by the CMA Health Care Reform and MACRA Technical Advisory Committees. The recommendations submitted by CMA would simplify the Medicare/Medicaid programs, reduce costs, improve quality, increase access to physicians and allow physicians to spend more time with their patients. CMA’s top 10 priorities for regulatory relief are: Reduce the quality and electronic health record (EHR) reporting burdens of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Enforce EHR vendor compliance and interoperability, and limit additional physician fees. Reform the Medicare Recovery Audit Contractor program, and pre- and post-payment review audits. Require Medicaid programs and Medicaid managed care plans to arrange and pay for interpreter services. Reduce health plan data requests of physicians related to Medicare advantage risk adjustment scores. Further delay and simplify the new imaging appropriate use criteria program. Remove lab certification requirements for physicians who use waived tests or physician performed microscopy. Rescind the Two-Midnight/Observation Care rule. Exempt physician in-office drug compounding from the new FDA rule. Change the Stark anti-kickback restrictions to allow more coordinated care alternative payment models. CMA also submitted comments on the proposed 2018 Medicare Physician Fee Schedule. CMA is pleased to note that there are a number of positive proposed changes that would help physicians improve patient care, including reduced penalties under the flawed Value Modifier program, additional coverage for telehealth services, expansion of the Medicare Diabetes Prevention Program, delay in the implementation of the Imaging Appropriate Use Criteria Program, and reduced documentation requirements for the Medicare Shared Savings ACO Program. This year also marks the second year of the CMA-sponsored California Geographic Practice Cost Index (GPCI) fix. The GPCI fix updated California’s Medicare physician payment regions in 2017 and will transition payment levels upwards for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts. However, CMA objected to the proposal to report 2016 Physician Quality Reporting System (PQRS) quality data on the public Physician Compare Website because the inaccuracy of the data could mislead patients. Finally, CMA urged CMS to focus fee schedule revisions on the evaluation and management (E/M) guidelines, not the E/M codes, and to remove the new requirement for physician-office labs to report private payor payment data on tests performed for patients. For more details on CMA’s priorities for regulatory relief, and CMA’s comments on the proposed fee schedule, click here. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. September 27, 2017 Medi-Cal, Medicare Medicaid, Medicare, Regulatory Relief 0 0 Comment Read More »
MACRA 90-day reporting deadline approaching Beginning with the 2017 reporting year, eligible physicians who do not participate in the Medicare Quality Payment Program (QPP) will see a negative 4 percent payment adjustment in 2019. QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and administered by the Centers for Medicare and Medicaid Services (CMS). During the 2017 transition year, CMS will allow physicians to select one of three “pick your pace” participation options. Participating at any level in 2017 will ensure that you will not be hit with the 4 percent pay cut in 2019. The most lenient participation option—reporting on one patient, one measure—allows physicians to avoid a penalty by "testing" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond. Physicians can choose to report for 90 days and possibly earn a small bonus payment. If you plan to select this 90-day reporting option, your performance period must begin no later than October 2, 2017. Physicians can also choose, if they are ready, to report a full year of data in 2017 and be eligible to receive a modest bonus, depending on their performance. Providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the reporting requirements in 2017. If you are unsure of your QPP participation status, you can look it up here. FREE assistance for small practices California physicians in practices of 15 or fewer can receive free assistance to prepare and participate in the QPP through the California Health Information Partnership & Services Organization (CalHIPSO). CalHIPSO will help you select the right participation “pace” for your practice, navigate the new landscape, assess performance data and stay informed about the QPP. Contact CalHIPSO now to register for services and receive no-cost technical assistance. CMA MACRA Resource Center To help physicians understand the payment reforms and prepare for the transition, CMA has published a MACRA resource page at www.cmanet.org/macra. There, you will find an overview of MACRA and a comprehensive list of tools, resources and information from CMA, the American Medical Association and CMS. September 27, 2017 Medicare CalHIPSO, MACRA, Medicare, Medicare Quality Payment Program (QPP), Webinars 0 0 Comment Read More »
Noridian reports spike in provider deactivations and lost revenue Noridian, Medicare’s administrative contractor for California, has seen a spike in the number of providers deactivated for not responding to Medicare revalidation notices, resulting in a gap in billing privileges and lost revenue for physicians. Noridian will send revalidation notices via email two or three months prior to the revalidation due date. Revalidation notices sent via email will indicate "URGENT: Medicare Provider Enrollment Revalidation Request" in the subject line to differentiate from other emails. If the email is returned as undeliverable, only then will Noridian will send a paper revalidation notice to the correspondence, special payments and/or primary practice address on file. Physicians don’t, however, have to wait for a revalidation letter. CMS has a look-up tool that allows a practice to look up an individual physician’s or organization’s revalidation date. Providers due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field. What physicians need to know: When responding to revalidation requests, it’s important to revalidate your entire Medicare enrollment record, including all reassignment and practice locations through internet-based PECOS or via the CMS 855 form. If you have multiple reassignments/billing structures, you must coordinate the revalidation application submission with each entity. If a revalidation application is received but incomplete, Noridian will contact you via email for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges. Do not assume that “no news is good news.” The contact person indicated on the application should receive an email notice of the application receipt, any discrepancies, and either a stop billing privileges or acknowledgement letter of approval. Check your spam filter if you’re not receiving these notices. Failure to revalidate may result in a deactivation of your Medicare billing privileges. If billing privileges are deactivated, a provider request to reactivate will result in the same Provider Transaction Access Number, but there will be a lapse in coverage with Medicare. The provider will be required to submit a new full and complete application in order to reestablish the enrollment record and related Medicare billing privileges. If the revalidation application is approved, the provider will receive email confirmation that the provider will be revalidated and no further action is needed. For more information on the revalidation process, see MLN Matters #SE1605. If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960. September 25, 2017 Medicare Medicare, Noridian, Provider Enrollment Chain and Ownership System 0 0 Comment Read More »
CMA urges CMS to further reduce MACRA administrative burdens The California Medical Association (CMA) recently submitted comments on proposed 2018 changes to the Medicare Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Though not perfect, CMA is pleased that the Centers for Medicare and Medicaid Services (CMS) has listened to physician feedback and has made changes that will significantly reduce the administrative burdens on physicians, particularly for small and rural practices. We appreciate the agency’s responsiveness to many of our concerns about the ability of physicians to successfully participate in the QPP. Under the proposed rule, 2018 will be another transition year like 2017. This means that physicians who report only one quality measure in 2018 can avoid all penalties in 2020. CMS estimates that under the proposed 2018 MACRA rule, 94 percent of physicians will earn either a positive or neutral payment adjustment in 2020 for the 2018 reporting year. Thirty-seven percent of physicians are expected to be exempt because of the low-volume threshold. The proposal would also allow virtual groups and provide bonus points for physicians treating complex patients. CMA is urging CMS to make additional changes to further reduce administrative burdens while allowing physicians to be innovative and improve care. Among the changes CMA is seeking are a reduction in the number of electronic health record (EHR) measures; expanding the adjustments for complex patients; removing the requirement to report all payer data; and exempting physicians within five years of retirement. CMA is also urging CMS to hold EHR vendors more accountable, particularly for interoperability. Major highlights of the proposed rule include: Continues 2018 as a “Pick Your Pace” transition year, during which physicians can easily avoid all penalties. Provides additional accommodations for small and rural practices, including automatic bonus points for small practices. Expands the total exemption to physicians with $90,000 or less in Medicare Part B allowed charges or 200 or fewer Medicare patients. Allows virtual groups to organize and help small practices pool resources to report successfully. Provides bonus points for physicians treating complex patients, including dual-eligible patients. The flawed “resource use” (physician cost) category will not count again for the 2018 reporting year. Continues to allow use of the 2014 edition of Certified Electronic Health Record Technology. Provides new Advancing Care Information (EHR) hardship exemptions for physicians in small practices. Provides exemptions from all Advancing Care Information (EHR) requirements if a physician’s EHR is decertified. Provides new bonus points for Advancing Care Information (EHR) requirements. Permits physicians to continue to report modified stage 2 meaningful use measures in 2018 instead of new stage 3 measures. Provides new options to use facility-based scoring for facility-based physicians who provide more than 75 percent of their services in an in-patient setting or through the emergency department. For Alternative Payment Models (APM), extends the current, more reasonable nominal financial risk requirement of 8 percent of total Medicare revenue for two more years. Reduces the financial risk requirements for APM medical homes. Reduces reporting burden for the Merit-Based Incentive Payment System and APMs For more details on CMA’s proposed MACRA changes, see CMA’s full comments, which are based on the recommendations of our MACRA Technical Advisory Committee. CMA will be working closely with the American Medical Association (AMA) and CMS to monitor the QPP’s effect on physician practices, the physician-patient relationship and access to care. CMA MACRA Resource Center To help physicians understand the MACRA payment reforms and prepare for the transition, CMA has published a MACRA resource page at www.cmanet.org/macra. There, you will find an overview of MACRA and a comprehensive list of tools, resources and information from CMA, AMA and CMS. Free MACRA assistance for California physicians The Health Services Advisory Group, in partnership with the California Health Information Partnership & Services Organization (CalHIPSO), is providing no-cost technical assistance to physician offices in California to help them prepare for and participate in the MACRA QPP. CalHIPSO is also hosting a CMA webinar on September 20 to answer physician questions about MACRA reporting. September 25, 2017 CMA, EHR, Managed Care CalHIPSO, MACRA, Medicare, Medicare Quality Payment Program, QPP, Webinars 0 0 Comment Read More »
CMS now accepting QPP hardship applications for 2017 The Centers for Medicare and Medicaid Services (CMS) is now accepting hardship exceptions from the Medicare Quality Payment Program (QPP) for the 2017 reporting year. Beginning with this reporting year, physicians who do not participate in QPP will see a negative 4 percent payment adjustment in 2019. Physicians who do participate may qualify for bonus payments. Physicians and groups that qualify for the QPP’s Merit-Based Incentive Payment System (MIPS) can submit a hardship exception application for one of the following reasons: Insufficient internet connectivity Extreme and uncontrollable circumstances Lack of control over the availability of certified electronic health record technology If you meet one of the criteria above, you may qualify for a reweighting of the Advancing Care Information performance category score to 0. The 25 percent weighting of the advancing care information category would be reallocated to the quality performance category There are also some MIPS eligible clinicians who are considered “special status,” who will be automatically reweighted (or exempted in the case of MIPS eligible clinicians participating in a MIPS alternative payment model) and do not need to submit a QPP hardship exception application. Hardship exception applications can be submitted via the QPP website. You can also contact the QPP Service Center at (866) 288-8292 or QPP@cms.hhs.gov and work with a representative to submit an application. Once an application is submitted, you will receive a confirmation email that your application was received and is pending, approved or dismissed. Applications will be processed on a rolling basis. Physicians should also be aware that 2017 is a transition year, with CMS offering “pick your pace” options for participation. Participating at any level in 2017 will ensure that you will not be hit with payment penalties in 2019. The most lenient participation option would allow physicians to simply "test" the program to ensure that their systems are working and that they are prepared for broader implementation in 2018 and beyond. While physicians who choose this option will not receive bonus payments, they will avoid a negative penalty. Providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the MIPS reporting requirements. Physicians who exceed this threshold are subject to MIPS and are encouraged to participate in MIPS for the 2017 transition year to avoid the negative payment adjustment. If you are unsure of your MIPS participation status, click here. California physicians in practices of 15 or fewer can receive free assistance to prepare and participate in Quality Payment Program through CalHIPSO. For more information visit www.hsag.com/CalHIPSO. The American Medical Association has also published a short instructional video to help physicians avoid being penalized under the QPP. The video offers step-by-step instructions on how to report on one patient for one measure to avoid a negative 4 percent payment penalty in 2019. For more information about the QPP, implemented with the Medicare Access and CHIP Reauthorization Act (MACRA), visit www.cmanet.org/macra. August 9, 2017 Medicare CalHIPSO, Centers for Medicare and Medicaid Services, CMS, MACRA, Medicare, Medicare Quality Payment Program (QPP), Merit-Based Incentive Payment System (MIPS) 0 0 Comment Read More »
CMS dedicates new webpage to Medicare Beneficiary Identification number change The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare and Medicaid Services (CMS) to remove Social Security numbers from Medicare cards to prevent identity theft. CMS has said it will in 2018 begin issuing new Medicare cards that replace the current identification number—which is the beneficiary's Social Security Number—with an all-new Medicare Beneficiary Identification (MBI) number. CMS has developed a new webpage to help physicians navigate the transition to the new MBI number, including a recently developed resource on how to talk to your Medicare patients about the new Medicare card. Physicians should also talk to their practice managers and health IT vendors now to ensure their systems will be ready to accept the MBI. What can physicians do now to prepare? Identify your patients who qualify for Medicare under the Railroad Retirement Board (RRB). You will no longer be able to distinguish RRB patients by the number on the new Medicare card. You will be able to identify them by the RRB logo on their card and a unique message on the eligibility transaction response. The message will say, "Railroad Retirement Medicare Beneficiary" in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA. Ensure your practice management system is ready to accept the new MBI numbers. Beginning in October 2018, through the transition period, CMS will return your patient's MBI on every electronic remittance advice for claims you submit with a valid and active HICN. It will be in the same place you now get the "changed HICN": 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code). Practices will need to ensure their system is prepared to accept the new format and length of the new ID numbers. August 8, 2017 Medi-Cal, Medicare CMS, Medicare, Centers for Medicare and Medicaid Services, MACRA 0 0 Comment Read More »
Updated payor profiles for 2017 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge in the CMA Resource Library. August 1, 2017 CMA, Managed Care, Medi-Cal, Medicare Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Insurance, Medi-Cal, Medicare, Noridian, Payor, Payor Profiles, Running a Practice, UnitedHealthcare 0 0 Comment Read More »
CMS releases proposed Medicare physician fee schedule for 2018 The Centers for Medicare & Medicaid Services (CMS) recently released the proposed 2018 Medicare Physician Fee Schedule. The California Medical Association (CMA) is pleased to note that there are a number of positive proposed changes that would help physicians improve patient care. CMS is also soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles. Highlights of the proposed rule include: Request for information on regulatory relief: CMA applauds CMS’ invitation for physicians to submit ideas for regulatory, policy, practice and procedural changes to improve the health care system to reduce unnecessary burdens for clinicians, patients and their families. CMA has met with CMS on several occasions this year to urge the agency to reduce regulatory burdens on physicians. CMA is compiling a list of regulatory reforms and will provide comments urging CMS to make it a top priority to provide regulatory relief to physicians in the Medicare and Medicaid programs. CMA’s list of reforms includes: reduced electronic health record (EHR) reporting; more EHR vendor accountability and assistance with usability; Medicare RAC and prepayment audit reforms; and requiring states and health plans to arrange and pay for Medicaid interpreter services. Expansion of the Diabetes Prevention Program (DPP): The proposal would expand coverage of the Medicare DPP model to all Medicare patients at risk of developing type 2 diabetes. This expansion will ensure at-risk seniors and people with disabilities have access to evidence-based DPPs that can help them lower their risk factors and prevent or delay the progression to type 2 diabetes. The new proposal provides more flexibility to DPP providers in supporting patient engagement and attendance, and by making performance-based payments available if patients meet weight-loss targets over a longer period of time. The Medicare DPP pilot program projected an estimated savings of $1.3 billion, prompting CMS to conclude last year that the expanded coverage would result in significant cost savings. This is a groundbreaking policy decision to cover and provide additional payment for evidenced-based prevention activities that improve patient health and reduce total health expenditures. Delayed implementation of appropriate use criteria: The proposal would delay implementation of a program created under the Protecting Access to Medicare Act that would have denied payment for advanced imaging services unless the physician ordering the service documented that they had consulted the appropriate use criteria. CMS has decided to postpone the implementation of this requirement until 2019 and to make the first year an opportunity for testing and education, where consultation would not be required as a condition of payment for imaging services. California Geographic Practice Cost Index: This year also marks the second year of the CMA-sponsored California Geographic Practice Cost Index (GPCI) fix. The GPCI fix updated California’s Medicare physician payment regions in 2017 and will transition payment levels upwards for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts. For more information, see the CMS Fact Sheet or read the full rule. CMA is currently reviewing the proposed rule and will provide more information at a later date. CMS is accepting comments on the proposed rule through September 11, 2017. The final rule is expected to be released in early November. July 24, 2017 Medicare CMS, Fee Schedule, Medicare, Regulatory Advocacy 0 0 Comment Read More »
CMA Open Payments data shows that only 5.6% of physicians looked at their records The Centers for Medicare and Medicaid Services (CMS) announced last week that in 2016, only 5.6 percent of physicians nationwide reviewed their data under the Medicare Open Payments program. Under the Open Payments program, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Medicare publicly released calendar-year 2016 Open Payments data on June 30 following a 45-day period during which physicians were able to review their data and dispute errors. According to CMS, only 34,871 physicians (5.6 percent) of the 630,824 physicians who received payments in 2016 registered to review their data. Physicians can still review the records and dispute the data even though the official review-and-dispute period ended on May 15. Unresolved disputes or corrections will be reflected in the next scheduled database update. Physicians who are not already registered should be aware that there is a two-step process to register for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Identity Management System portal, a step many physicians may have already completed as the gateway enables access to some other CMS programs. Step two is to register in CMS’ Open Payments system. Physicians who have already registered, but who have not accessed their account in the past 60 days, will need to unlock their account by going to the CMS Enterprise Portal. It will prompt you to enter your user ID and correctly answer all challenge questions, then you will be prompted to enter a new password. Users who registered last year, but who have been inactive for more than 180 days, will need to reactivate their account by contacting the Open Payments Help Desk at openpayments@cms.hhs.gov or (855) 326-8366. July 24, 2017 Medicare CMS, Medicare, Medicare Open Payments Program 0 0 Comment Read More »
Survey finds nation's physicians not ready to fulfill MACRA reporting requirements Fewer than one in four physicians feel ready to meet the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) reporting requirements, according to a survey of 1,000 physicians conducted by the American Medical Association (AMA). QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). It replaces the fee-for-service reimbursement model with two paths to choose from: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Over half of those surveyed (56 percent) plan to participate in MIPS in 2017, which provides variable incentive payments or penalties based on certain quality and efficiency measures, while 18 percent are expecting to qualify for higher and more stable payments as APM participants. The survey also found that a majority (51 percent) of physicians who are involved in practice decision-making feel somewhat knowledgeable about MACRA and the QPP, but only 8 percent describe themselves as “deeply knowledgeable” about the program and its requirements. Additionally, 90 percent felt the reporting requirements were “somewhat” or “very” burdensome. AMA, the California Medical Association (CMA) and other physician groups have stressed to CMS the importance of establishing a QPP transition period. As a direct result of this advocacy, physicians only need to report on one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under MIPS. CMS has also proposed extending the transition into 2018. To help physicians understand the payment reforms and prepare for the transition, CMA has published a MACRA resource page at www.cmanet.org/macra. There, you will find an overview of MACRA and a comprehensive list of tools, resources and information from CMA, AMA and CMS. New to the resource center is a brief instructional video by AMA, “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting." July 24, 2017 Medicare MACRA, Medicare, Merit-Based Incentive Payment System, Alternative Payment Models (APM) 0 0 Comment Read More »
