New video shows physicians how to avoid Medicare payment penalties The American Medical Association (AMA) has published a short instructional video to help physicians avoid being penalized under the new Medicare Quality Payment Program (QPP). QPP is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and is administered by the Centers for Medicare and Medicaid Services (CMS). Because QPP is new this year, AMA and the California Medical Association (CMA) want to make sure physicians know what they have to do to participate in QPP’s “pick your pace” options for reporting. This is especially important for physicians who have not participated in past Medicare reporting and programs and may be less knowledgeable about the steps they can take to avoid being penalized under QPP. AMA, CMA and other physician groups stressed to CMS the importance of establishing a transition period to QPP. As a result, physicians only need to report on at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-Based Incentive Payment System (MIPS). The video, “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” offers step-by-step instructions on how to report so physicians can avoid a negative 4-percent payment adjustment in 2019. CMA has also published a MACRA resource page at www.cmanet.org/macra to help physicians understand the new payment reforms and what they can do now to start preparing for the transition. Also available in the CMA MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, AMA and CMS. July 21, 2017 Medicare MACRA, Medicare 0 0 Comment Read More »
Noridian to issue electronic Level 1 Medicare Redetermination Notices via web portal Effective June 16, 2017, providers who submit their redetermination and/or reopening requests through the Noridian Medicare Portal (NMP) will now receive their Level 1 Medicare Redetermination Notices (MRNs) via NMP. If a redetermination or reopening outcome results in a fully favorable (payable) determination, the remittance advice will provide details. For all other decisions in which providers receive an MRN, the determination letters will now be available through the Appeal Status Inquiry feature in NMP only. Practices that submit electronic reopening and redetermination requests should ensure that any assigned staff member is registered as an NMP user, as MRNs will no longer be mailed in these cases. Noridian encourages the submission of electronic reopening and redetermination requests and all supporting documentation (10 mb per file; unlimited number of file submissions per claim) via NMP. This submission method ensures that the requests contain all required information, including the signature on Redetermination requests. July 21, 2017 Medicare Medicare, Noridian 0 0 Comment Read More »
Significant improvements in 2018 MACRA rule The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Though not perfect, the California Medical Association (CMA) is pleased that 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. 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. MACRA repealed the fatally flawed sustainable growth rate (SGR) payment system, which governed how physicians and other clinicians were paid under Part B of the Medicare program. It replaced the SGR and its fee-for-service reimbursement model with two paths: The Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). CMS will begin measuring performance for eligible clinicians in 2017, with payments based on those results beginning in 2019. 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. Major highlights: Allows the creation of virtual groups to assist small practices. Significantly expands the low-volume threshold to $90,000 or less in Medicare Part B allowed charges OR 200 or fewer Medicare Part B patients (previously the threshold was $30,000 in allowed charges or 100 patients). CMS estimates that only 37 percent of clinicians who bill Medicare will be subject to MIPS with this larger exception. Provides automatic bonus points for small practices. Adds a hardship exemption from the electronic health records (EHR) category for small practices. Provides opportunities to achieve bonus points in the EHR category, with physicians only needing to report on Stage 2 measures instead of Stage 3. Provides bonus points for treating complex patients, such as dual eligibles. Physicians will not be scored on "resource use" (physician cost) in 2017. Reduces the Medicare revenue and patient threshold to qualify for APMs. CMA will submit comments on the proposed rule and will continue to fight for improvements to the MACRA regulations to reduce administrative burdens and open up more opportunities for fair payment. For more details on the new rule, see the CMS Fact Sheet. July 21, 2017 Managed Care, Medicare CMA, MACRA, Medicare, Regulatory Advocacy 0 0 Comment Read More »
MIPS group reporting registration period ends June 30 Physician groups planning to use the Centers for Medicare and Medicaid Services (CMS) web interface or the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient satisfaction survey data to satisfy requirements of the new Merit-Based Incentive Payment System (MIPS) must register by June 30, 2017. Please note that registration is only required if a group chooses to submit data using one of these two mechanisms. Groups do not need to register if they plan to submit MIPS data through other submission methods, such as a qualified registry, qualified clinical data registry, shared savings program accountable care organization or electronic health record. For step-by-step registration instructions, check out the 2017 Registration Guide for the CMS Web Interface or CAHPS for MIPS Survey. Physicians can visit the California Medical Association’s (CMA) MACRA resource center to better understand the payment reforms and to access resources to help with the transition. The center is a one-stop-shop with tools, checklists and information from CMA, CMS, the American Medical Association and national specialty society clinical data registries. Additional information is available on the CMS Quality Payment Program website. June 21, 2017 CMA, Medicare MACRA, Medicare 0 0 Comment Read More »
CMS to issue MIPS participation status notices Starting in late April, the Centers for Medicare & Medicaid Services (CMS) began notifying physicians whether they will be subject to Medicare's new Merit-Based Incentive Payment System (MIPS). MIPS is part of the new Medicare Quality Payment Program established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 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 a negative payment adjustment. Over the next month, physicians will be receiving letters from CMS informing them if they, or the individuals in their group, are exempt from MIPS. The letter also advises physicians to review their information and determine whether they plan to participate as an individual physician or as a group, how to avoid a penalty or possibly earn a positive adjustment, and includes an FAQ with additional information. For clinicians participating under multiple TINs, a separate notification will be sent to reflect each TIN. If you did not receive a letter, you can confirm your participation status using the CMS MIPS participation lookup tool. Physicians can visit the California Medical Association (CMA) MACRA resource center to better understand the payment reforms and access resources to help with the transition. The center is a one-stop-shop with tools, checklists and information from CMA, CMS, the American Medical Association and national specialty society clinical data registries. View the CMA resource center at www.cmanet.org/macra or visit the CMS Quality Payment Program website for more information. May 22, 2017 General, Managed Care, Medicare CMS, MACRA, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS delays reporting deadline for physician labs The Centers for Medicare and Medicaid Services (CMS) has announced that it will delay the deadline for physician office-based laboratories to meet new reporting requirements. Qualified laboratories now have until May 30, 2017, to complete reporting of private payor payment data for clinical testing services, as required by the Protecting Access to Medicare Act (PAMA). Under PAMA, laboratories that meet revenue thresholds are required to report private payor payment rates and associated volumes for tests they perform that are paid on the Clinical Laboratory Fee Schedule (CLFS). CMS said it will use data collected to set new payment rates for these tests, a move that is expected to result in decreased reimbursement for these services. In an effort to preserve point-of-care testing and to stave off the decrease in rates, the American Medical Association (AMA) sent a letter requesting a one-year delay in the implementation of the new CLFS and that CMS work with the physician community to find an appropriate path forward that would preserve point-of-care testing in physician office-based laboratories. The California Medical Association supports AMA’s actions. More information on the announcement by CMS and the PAMA reporting requirements are available on the CMS website. April 19, 2017 General Centers for Medicare and Medicaid Services, Clinical Laboratories, CMS, Medicare, Regulatory Advocacy 0 0 Comment Read More »
CHPI publishes physicians' quality ratings for cycle 2 On March 22, 2017, the California Healthcare Performance Initiative System (CHPI) released its second cycle of physician quality ratings to the public. The ratings can be accessed at CHPI’s newly launched website, CAqualityratings.org, which allows consumers to search ratings on approximately 10,000 California physicians. As previously reported in September 2016, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the CHPI quality rating program. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products. The individual quality measurement scores were based on claims data for patient care provided January 1, 2012, through December 31, 2014. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure as well as a composite score. For more information on the CHPI Cycle 2 rating methodology, visit the CHPI website at www.chpis.org. CHPI has also published an FAQ on its rating program. If you have questions or concerns about the CHPI rating results, email chpicorrections@pbgh.org and expect a response within 48 hours. April 19, 2017 Managed Care, Medicare Managed Care, Medicare, CHPI, Quality of Care 0 0 Comment Read More »
CMA updates MACRA preparation checklist The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra. CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information from CMA, the American Medical Association and the Centers for Medicare and Medicaid Services. April 19, 2017 Managed Care, Medicare Practice Management, Insurance/Reimbursement, Medicare 0 0 Comment Read More »
CMS to remove SSNs from all Medicare cards by April 2019 The Centers for Medicare & Medicaid Services (CMS) will remove social security numbers (SSNs) from all Medicare cards by April 2019, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). As part of the Social Security Number Removal Initiative, a new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) for all Medicare transactions. The MBI is confidential like the SSN, and should be protected as personally identifiable information. By replacing the SSN-based HICN on all Medicare cards, private health care and financial information and federal health care benefit and service payments will be better protected. Moving to new Medicare numbers and cards will require changes to provider systems and how they conduct business. Practices should assess the potential impact on their business operations, including whether their practice management software can accept and process transactions using the new MBI. Additionally, practices may find that additional time is required to educate patients on the purpose of the new Medicare cards and MBI, to advise that the new MBI will not change patients’ Medicare benefits. Beginning in April 2018, CMS will start sending the new Medicare cards with the MBI to all Medicare beneficiaries. People with Medicare may start using their new Medicare cards and MBIs as soon as they receive them. There will be a transition period, beginning no earlier than April 1, 2018, through December 31, 2019, where providers can use either the HICN or the MBI. The MBI will be: Clearly different than the HICN 11 characters in length Made up only of numbers and uppercase letters (no special characters) For MBI specifications and to make changes to your systems, see the MBI format specifications. More information regarding the Social Security Number Removal Initiative can be found on the CMS.gov website. April 19, 2017 Medicare Insurance/Reimbursement, MACRA, Medicare 0 0 Comment Read More »
CMS awards $100 million to help small practices succeed The Centers for Medicare & Medicaid Services (CMS) has awarded $20 million to 11 organizations for the first year of a five-year project to provide on-the-ground training and education about the Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), for clinicians in individual or small group practices. CMS intends to invest up to an additional $80 million over the remaining four years. Among the awardees are three California organizations: IPRO in San Francisco, Health Services Advisory Group in Glendale and Burlingame, and Qualis Health in Irvine. These local, experienced, community-based organizations will provide hands-on training to help small practices (15 clinicians or fewer), especially those that practice in rural and under-resourced areas. The training and education resources should be available immediately, and will be provided at no cost to eligible clinicians and practices. According to CMS, clinicians will receive help choosing and reporting on quality measures, as well as guidance with all aspects of the program, including supporting change management and strategic planning, and assessing and optimizing health information technology. The California Medical Association and the American Medical Association fought to include language in the Medicare reform law to provide this direct assistance to small and rural practices to help them comply with MACRA’s Merit-Based Incentive Payment System and transition to new payment models. As part of that outreach effort, CMS also launched a new helpline for clinicians seeking assistance with the Quality Payment Program. The helpline can be reached by calling (866) 288-8292 from 8 a.m. to 8 p.m. EST, or emailing qpp@cms.hhs.gov. March 3, 2017 General, Medicare Medicare, CMS, MACRA, Quality Reporting 0 0 Comment Read More »
