Bills introduced to stop IPAB California Congressman and physician Raul Ruiz, M.D., (D-Palm Springs) and Senate Finance Committee Ranking Member Ron Wyden (D-OR) recently introduced bills that that would prevent the Medicare Independent Payment Advisory Board (IPAB) from moving forward. IPAB was to be a 15-member federal agency with the task of achieving specified savings in Medicare without affecting coverage or quality. It was established by the Affordable Care Act and up until now has not been implemented. The board was charged with making recommendations to reduce per capita spending growth in Medicare if spending growth exceeds a specified target. The California Medical Association (CMA) has long advocated for the board’s elimination. CMA is concerned that strict budgetary targets and other limitations imposed on the panel would ultimately threaten the ability of the nation’s seniors and disabled to obtain health care because the cuts directed by IPAB would disproportionally fall on physicians and negatively impact access to care. “Given the Trump administration’s short but disturbing record of irresponsible and cruel executive actions, it would be a huge mistake to leave in place the authority to push through harmful cuts to Medicare with minimal input from Congress,” Wyden said. Senator John Cornyn (R-TX) and Representative Phil Roe, M.D., (R-TN) have introduced similar bills. CMA applauds the actions of these representatives, particularly our own physician Congressman, Dr. Ruiz, to eliminate the IPAB once and for all. March 2, 2017 Medicare Federal Legislation, Medicare 0 0 Comment Read More »
Meaningful use reporting deadline pushed back two weeks to March 13 The Centers for Medicare & Medicaid Services (CMS) on Monday announced that physicians would have two additional weeks to register and attest to meaningful use for 2016 and avoid the 2018 penalty. Physicians now have until Monday, March 13, to attest for the 2016 reporting year. Two weeks ago, hospitals also received a similar reprieve. Physicians should note that CMS is only extending the attestation period, not the reporting period, so physicians must have concluded their reporting by December 31, 2016. Although the Medicare meaningful use program is being phased out this year, physicians are still required to report meaningful use measures for 2016 to avoid a 3 percent Medicare penalty in 2018. According to CMS, approximately 171,000 physicians are expected to be penalized this year because they didn't attest to meaningful use for 2015. Medicare meaningful use reporting will end in 2017, with eligible clinicians who do not participate in the new advanced alternative payment models transitioning to Medicare's new Merit-Based Incentive Payment System (MIPS). To attest, providers should submit their data through the CMS registration and attestation system. Physicians may select an EHR reporting period of any continuous 90 days from January 1, 2016, through December 31, 2016. CMA recommends that physicians attest during off-peak hours, such as evenings and weekends, to speed up the attestation process. Physicians are also urged to take time now to ensure that their Medicare enrollment information is up-to-date before entering their 2016 attestation data. Review the CMS Registration and Attestation Resources Page for other tips to success. Please note the deadline referenced above only applies to the Medicare EHR program, not the Medicaid (Medi-Cal in California) program. For more details on the Medi-Cal program and deadlines, see http://medi-cal.ehr.ca.gov. March 2, 2017 Medicare Meaningful Use, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
2017 Medicare EHR payment adjustment reconsideration forms due February 28 Eligible physicians who have been identified as being subject to Medicare electronic health record (EHR) payment penalties in 2017 (based on the 2015 reporting period), and believe that determination to be in error, have until February 28, 2017, to submit a reconsideration form to the Centers for Medicare and Medicaid Services (CMS). The reconsideration form can be downloaded from the CMS website. For reconsideration instructions, click here. If you have questions about the reconsideration process, please email pareconsideration@provider-resources.com. For more information on payment adjustments and hardship applications, or for information on reporting requirements, please visit the CMS EHR Incentive Programs web page. February 23, 2017 Medicare CMS, EHR, Electronic Health Record, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS erroneously warns some physicians of 2017 meaningful use penalties Providers who attested to meaningful use with the Medi-Cal Electronic Health Record (EHR) Incentive Program for program year 2015 are exempt from Medicare payment adjustments in 2017. Because the California Department of Health Services pushed back the deadline to submit meaningful use applications for the 2015 program year to December 13, 2016, the agency was not able to send information to the Centers for Medicare and Medicaid Services (CMS) regarding 2015 Medi-Cal meaningful use attestations until late in December 2016. For this reason, some Medi-Cal providers are now erroneously receiving letters from CMS warning that they are subject to Medicare payment adjustments in 2017. These letters offer providers the option of filling out and sending in a “reconsideration form” to CMS to avoid the payment adjustments. DHCS has received assurance from CMS that all providers who attested to meaningful use with the Medi-Cal EHR Incentive Program for 2015, even as late as December 13, 2016, will not be subject to Medicare payment adjustments in 2017. Submission of the reconsideration form should not be necessary because CMS has now removed the names of all providers who had attested to meaningful use for 2015 with the Medi-Cal EHR Incentive Program from the list of providers subject to payment adjustments in 2017. While a reconsideration form is not required, if you have already filed a reconsideration form, no further action is necessary. Because no Medicare payments for 2017 dates of service were paid before CMS updated its records with California’s 2015 attestation data, no 2017 payments were affected by the error. If you think you received a notice of 2017 payment adjustment in error, you can check the list of providers who attested to meaningful use in 2015 on the DHCS website. Any additional questions can be directed to medi-cal.ehr@dhcs.ca.gov. February 13, 2017 Medi-Cal, Medicare Department of Health Care Services, EHR, Meaningful Use, Medi-Cal, Medicare, CMS 0 0 Comment Read More »
Deadline extended to dispute 2015 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. Today, CMS announced that physicians who have concerns about the findings in their report(s) have until December 7 to file for an informal review of their data. The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully complete required PQRS reporting in 2015 will result in a 2 percent penalty in 2017. VM penalties can range from 1 to 4 percent, depending on the size of the practice and its performance on cost and quality measures. PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. VM penalties can be found in the Quality and Resource Use Reports (QRUR), which are only posted on the website. Physicians may access both their 2015 PQRS feedback reports and QRURs on the CMS Enterprise Portal using an Enterprise Identity Management account. For details on how to obtain your QRUR report, see “How to obtain a QRUR” on the CMS.gov webpage. For information on obtaining your PQRS report, see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports.” For information on understanding your report, see the “2015 PQRS Feedback Report User Guide.” Both of the PQRS guides are available on the PQRS Analysis and Payment webpage. Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review. Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data. All informal review requests must be submitted electronically through the Quality Reporting Communication Support Page by December 7, 2016, at 11:59 p.m., ET. Physicians wishing to request an informal review of their QRUR and VM results should contact the Physician Value Help Desk at (888) 734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov. CMS also has published the “2017 Value Modifier Informal Review Request Quick Reference Guide.” Practices will be contacted by email with a final decision from CMS within 90 days of the original request for an informal review. All decisions will be final, with no opportunity for further review. Practices that do not receive a response are encouraged to check their junk or spam email folders for the decision. For additional questions, please contact the QualityNet Help Desk at (866) 288-8912 [TTY: (877) 715-6222] or via qnetsupport@hcqis.org between the hours of 7 a.m. and 7 p.m., CT, Monday through Friday. For information regarding other Medicare physician quality programs that apply payment adjustments, please see the Value-Based Payment Modifier website. For step-by-step instructions on how to implement PQRS, view the How to Get Started page. Additionally, the California Medical Association (CMA) updated its resource, “2016 PQRS and Value-Based Modifier Getting Started Guide,” which is available free to CMA members in the resource library at www.cmanet.org. December 6, 2016 General, Medicare Medicare, PQRS, Value-Based Payment Modifier 0 0 Comment Read More »
2017 Medicare fee schedule includes $140 million in additional funding for primay care The Centers for Medicare and Medicaid Services (CMS) on Wednesday released the final 2017 Medicare physician fee schedule. The fee schedule transforms how Medicare pays for primary care through a new focus on care management and behavioral health, which is expected to result in an additional $140 million in payments next year for physicians providing these services. The 2017 physician fee schedule focuses on improving Medicare payments for services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities. These changes will improve payment for clinicians who are making investments of time and resources to provide more coordinated and patient-centered care. These coding and payment changes will better reflect the resources involved in furnishing contemporary primary care, care coordination and planning, mental health care and care for cognitive impairment, such as Alzheimer’s disease. According to CMS, the coding and payment changes in the 2017 fee schedule could over time lead to $4 billion or more in additional support for care coordination and patient-centered care. The rule also begins to implement the California Medical Association (CMA) sponsored California Geographic Practice Cost Index (GPCI) fix, which will overhaul California’s outdated geographic payment localities. This reform will raise payment levels for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts (the hold harmless provisions will take effect in 2018). All California payment localities will transition to Metropolitan Statistical Areas. The transition to the new localities starts next year, with higher payments being phased in over a six-year period (2017-2022). Unfortunately, the California GPCI malpractice expenses and rent expenses went down in California and many other regions of the country. Therefore, most California physicians will experience an overall GPCI rate reduction in 2017. The general GPCI cut would have been larger if the California GPCI fix was not being simultaneously enacted. (To see the net GPCI payment impact by region, click here). The fee schedule also finalizes the CMS proposal to expand the Medicare Diabetes Prevention Program (DPP) model to all Medicare patients at risk of developing type 2 diabetes starting January 1, 2018. Expansion of the DPP model will help at-risk seniors and people with disabilities lower their risk factors and prevent their condition from advancing to type 2 diabetes. This marks the first time a prevention model from the CMS Innovation Center will be adopted. For more information, see the CMS fact sheet. CMA and the American Medical Association are reviewing the details of the final rule and will provide additional information in the near future. November 14, 2016 Medicare Fee Schedule, Geographic Practice Cost Index, GPCI, MACRA, Medicare 0 0 Comment Read More »
Don't forget: Last day to change your Medicare participation status for 2017 is December 31 Once again, it’s time for physicians to decide if they want to make changes to their Medicare participation status. Physicians have until December 31, 2016, to make changes for 2017. Although Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) penalties will not kick in until 2019, there are two more years of penalties that will be applied based on 2015 performance—tied to the meaningful use, Physician Quality Reporting System and Value-Based Modifier reporting programs. This will also decrease the limiting charge amounts that nonparticipating physicians can bill to patients for unassigned claims. As always, physicians have three choices regarding Medicare: Be a participating provider; be a non-participating provider; or opt out of Medicare entirely. Details on each of the three participation options are as follows: A participating physician must accept Medicare-allowed charges as payment in full for all Medicare patients. A non-participating provider can make assignment decisions on a case-by-case basis and bill patients for more than the Medicare allowance for unassigned claims. Non-participating physician fees are 95 percent of participating physician fees. If you choose not to accept assignment, you can charge the patient 9.25 percent more than the amounts allowed in the participating physician fee schedule (which equates to 15 percent of the non-participating fees). Physicians who opt out of Medicare are bound only by their private contracts with their patients. Medicare's limiting charges do not apply to these contracts, but Medicare does specify that these contracts contain certain terms. When a physician enters into a private contract with a Medicare beneficiary, both the physician and patient agree not to bill Medicare for services provided under the contract. Physicians who want to change their participation status for 2017 must send a letter to Noridian, California’s Medicare contractor, postmarked by December 31, 2016. The California Medical Association (CMA) also has information on physicians' Medicare participation options in CMA On-Call document #7209, "Medicare Participation (and Nonparticipation) Options." On-Call documents are free to members in CMA's online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase On-Call documents for $2 per page. Physicians can also visit CMA’s MACRA resource center at www.cmanet.org/macra 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, the Centers for Medicare and Medicaid Services, the American Medical Association and national specialty society clinical data registries. Contact: Cheryl Bradley, (213) 226-0338 or cbradley@cmanet.org. November 14, 2016 Medicare Medicare 0 0 Comment Read More »
Physicians have until November 30 to dispute 2015 PQRS and QRUR findings The Centers for Medicare and Medicaid Services (CMS) recently released data that indicates which physicians will be subject to the 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. Physicians who have concerns about the findings in their report(s) have until November 30 to file for an informal review of their data. The penalties in question stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA). Failure to successfully complete required PQRS reporting in 2015 will result in a 2 percent penalty in 2017. VM penalties can range from 1 to 4 percent, depending on the size of the practice and its performance on cost and quality measures. PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. VM penalties can be found in the Quality and Resource Use Reports (QRUR), which are only posted on the website. Physicians may access both their 2015 PQRS feedback reports and QRURs on the CMS Enterprise Portal using an Enterprise Identity Management account. For details on how to obtain your QRUR report, see “How to obtain a QRUR” on the CMS.gov webpage. For information on obtaining your PQRS report, see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports.” For information on understanding your report, see the “2015 PQRS Feedback Report User Guide.” Both of the PQRS guides are available on the PQRS Analysis and Payment webpage. Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review. Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data. All informal review requests must be submitted electronically through the Quality Reporting Communication Support Page by November 30, 2016, at 11:59 p.m., ET. Physicians wishing to request an informal review of their QRUR and VM results should contact the Physician Value Help Desk at (888) 734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov. CMS also has published the “2017 Value Modifier Informal Review Request Quick Reference Guide.” Practices will be contacted by email with a final decision from CMS within 90 days of the original request for an informal review. All decisions will be final, with no opportunity for further review. Practices that do not receive a response are encouraged to check their junk or spam email folders for the decision. For additional questions, please contact the QualityNet Help Desk at (866) 288-8912 [TTY: (877) 715-6222] or via qnetsupport@hcqis.org between the hours of 7 a.m. and 7 p.m., CT, Monday through Friday. For information regarding other Medicare physician quality programs that apply payment adjustments, please see the Value-Based Payment Modifier website. For step-by step instructions on how to implement PQRS, view the How to Get Started page. Additionally, the California Medical Association (CMA) updated its resource, “2016 PQRS and Value-Based Modifier Getting Started Guide,” which is available free to CMA members in the resource library at www.cmanet.org. November 14, 2016 Managed Care, Medi-Cal, Medicare Quality Reporting, Medicare, Physician Quality Reporting System, PQRS 0 0 Comment Read More »
California GPCI fix implementation to begin in January Last week, the Centers for Medicare and Medicaid Services (CMS) released the final Medicare physician fee schedule for 2017, which begins implementation of the long overdue overhaul of California’s outdated geographic payment localities. The California Geographic Practice Cost Index (GPCI) fix will update California’s Medicare physician payment regions and raise payment levels for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless (starting in 2018) from cuts. All California payment localities will transition to Metropolitan Statistical Areas. The transition to the new localities starts next year, with higher payments being phased in over a six-year period, from 2017-2022. Unfortunately, the GPCI malpractice expenses and rent expenses went down in California and many other regions of the country. This means that most California physicians will experience an overall GPCI rate reduction in 2017. The general GPCI cut would have been larger if the California GPCI fix was not being simultaneously enacted. Click here to see the net GPCI payment impact by region. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. November 8, 2016 Medicare Geographic Practice Cost Index, GPCI, Medicare 0 0 Comment Read More »
MACRA does not create new reporting burdens, is significant improvement over existing law On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) issued the final rule to implement the Medicare Access and CHIP Reauthorization Act of 2015, known as MACRA. The final regulation represents a significant improvement over the existing Medicare payment system and quality reporting programs. The California Medical Association (CMA), the American Medical Association (AMA) and 788 other physician organizations supported the MACRA legislation because it reduces the administrative burdens in the Medicare fee-for-service quality and electronic health record (EHR) reporting programs. The MACRA legislation and the implementing regulations revised the existing reporting programs and will significantly reduce the administrative burdens on physicians. Contrary to popular myth, MACRA does not create new reporting burdens. Legislative intent Repeal the Medicare sustainable growth rate (SGR) formula, which threatened payment cuts and stagnated physician payments for over a decade. Allow physicians to develop innovative physician-led alternative payment models. Provide stable annual updates in the Medicare fee-for-service program. Consolidate, streamline and reduce the administrative burdens in the Medicare quality and EHR meaningful use reporting programs. Penalties lower, bonuses higher Before MACRA, physicians were facing double-digit SGR payment cuts and 11 to 13 percent or more in payment penalties for not meeting the all-or-nothing requirements in the three Medicare reporting programs (Physician Quality Reporting System, EHR Incentive Program and Value-Based Payment Modifier). Under MACRA, physicians will be exempt from penalties in 2019 if they report on just one quality measure in 2017. In 2020, the maximum penalty is 5 percent, eventually going up to a maximum of 9 percent in 2022, but physicians would have faced much higher penalties under the pre-MACRA payment rules. Before MACRA, the Medicare bonus payments had all expired. MACRA restores bonus payments of up to 9 percent, plus an additional bonus for exceptional performance. Click here to see a chart that compares current law payments, bonuses and penalties to MACRA. Improvements over current law Though not perfect, the final MACRA rule, which takes effect January 1, 2017, is clear improvement over current law. While CMA is still reviewing the final rule, below are key improvements that CMA and AMA fought to achieve: Restores the 0.5 percent payment update for 2017. Exempts one-third of all Medicare physicians from MACRA's Merit-Based Incentive Payment System (MIPS) reporting program. Eliminates all of the meaningful use and value modifier quality measures. Reduces by half the remaining number of measures that physicians must report, from 30 to 15. Small and rural practices must report on even fewer measures. Eliminates the EHR Clinical Decision Support and Computerized Physician Order Entry measures. Eliminates penalties in 2019 (for the 2017 performance period) for physicians who report for one patient on one quality measure, one improvement activity OR the four EHR measures. Only requires physicians to report for 90 days in 2017 to receive a bonus in 2019. Only requires physicians to report on 50 percent of their patients in 2017 for the quality category. Mostly eliminates the pass/fail system and provides proportional credit for the measures that are met. Providers will not be scored on "resource use" (physician cost) in 2017 Expands the types of alternative payment models (APM) that can participate in MACRA, most notably Track 1 accountable care organizations. The final rule also reduces the financial risk requirements for APMs. CMA will continue to fight for improvements to the MACRA regulations and the law to reduce the administrative burdens and open up more opportunities for fair payment. For a summary of the final MACRA rule, visit https://qpp.cms.gov. Physicians can also visit CMA’s MACRA resource center at www.cmanet.org/macra to access information and resources to help with the transition. The center is a one-stop-shop with tools, checklists and information from CMA, CMS, AMA and national specialty society clinical data registries. CMA will add an updated summary and materials, including additional webinars, to the resource center in the coming weeks. November 7, 2016 Medicare MACRA, Medicare 0 0 Comment Read More »
