Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule with comment period. This is the first year the two rules have been combined. CMS also issued QPP and PFS fact sheets on the proposed rule. CMS is accepting comments on the proposed rule through September 10, 2018. The final rule is expected to be released in early November. American Medical Association staff is continuing to conduct a detailed review of the proposed rule and will work with our colleagues in the federation to further analyze and draft responses to these proposals in the coming weeks. To that end, we would greatly appreciate other medical societies and physician organizations sharing with us their thoughts on the proposed policies. July 25, 2018 Managed Care, Medicare CMS, PFS, Physician Fee Schedule, QPP, Quality Payment Program 0 0 Comment Read More »
10 Things to Do and Know About MIPS Reporting Deadlines Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don’t wait until the last minute to submit your data. Submit early and often. The two key dates are: March 16 at 8 pm Eastern time for group reporting via the CMS web interface March 31 for all other MIPS reporting, including via qpp.cms.gov Now is the time to act. Here are the top 10 things you need to do and know if you are an eligible clinician. This list focuses on reporting via the qpp.cms.gov data submission feature, not on group reporting on via the CMS Web Interface and not on individual reporting on Quality measures via claims submission data. Note: If you’re not sure if you are required to report for MIPS, enter your National Provider Identifier (NPI) in the MIPS Lookup Tool to find out whether you need to report. Additionally, if you know you are in a MIPS APM or Advanced APM, you can use the APM Lookup Tool. Visit qpp.cms.gov and click on the “Sign-In” tab to use the data submission feature. Check that your data are ready to submit. You can submit data for the Quality, Improvement Activities, and Advancing Care Information performance categories. Have your CMS Enterprise Identity Management (EIDM) credentials ready, or get an EIDM account if you don’t have one. An EIDM account gives you a single ID to use across multiple CMS systems. Sign in to the Quality Payment Program data submission feature using your EIDM account. Begin submitting your data early. This will give you time to familiarize yourself with the data submission feature and prepare your data. The data submission feature will recognize you and connect your NPI to associated Taxpayer Identification Numbers (TINs). Group practices: - A practice can report as a group or individually for each eligible clinician in the practice. You can switch from group to individual reporting, or vice versa, at any time. - The data submission feature will save all the data you enter for both individual eligible clinicians and a group, and CMS will use the data that results in a higher final score to calculate an individual MIPS-eligible clinician’s payment adjustment. You can update your data up to the March 31 deadline. The data submission feature doesn’t have a “save” or “submit” button. Instead, it automatically updates as you enter data. You’ll see your initial scores by performance category, indicating that CMS has received your data. If your file doesn’t upload, you’ll get a message noting that issue. You can submit data as often as you like. The data submission feature will help you identify any underperforming measures and any issues with your data. Starting your data entry early gives you time to resolve performance and data issues before the March 31 deadline. For step-by-step instructions on how to submit MIPS data, check out this video and fact sheet. If you are in an ACO or other APM, make sure you are working with your ACO or APM to make sure they have any patient information they need to report. Remember you need to report on Advancing Care Information measures on your own. Questions about your participation status or MIPS data submission? Contact the Quality Payment Program Service Center by: • Email: qpp@cms.hhs.gov • Phone: 1-866-288-8292 (TTY: 1-877-715-6222) Reprinted from Centers for Medicare & Medicaid Services Quality Payment Program. February 8, 2018 General Center for Medicare & Medicaid Services, CMS, MACRA , MIPS, QPP, quality payment program 0 0 Comment Read More »
CMS National Provider Calls include discussions on PQRS and Physician Compare in September The Centers for Medicare and Medicaid Service’s (CMS) September 2017 National Provider Call topics include the Physician Quality Reporting System (PQRS) on September 26 and on Physician Compare on September 28. PQRS provider call: While 2016 was the last program year for PQRS and the final data submission time frame for reporting 2016 PQRS quality data to avoid the 2018 payment penalty was January through March 2017, this call will cover PQRS penalties, feedback reports, and the informal review process for 2016 results and 2018 payment adjustment determinations. For more information and to register, click here. Physician Compare provider call: This call is for individuals interested in learning more about Physician Compare, a database with demographic information, performance scores and participation information for clinicians and groups who took part in CMS quality programs. The call will cover the upcoming 30-day preview period for the 2016 performance data targeted for release in December, the future of public reporting and what is coming in the next year. For more information or to register, click here. September 27, 2017 Medi-Cal, Medicare CMS, Physician Compare, Physician Quality Reporting System, PQRS 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 »
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 »
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 »
Open Payments review and dispute period open Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians during 2016. Physicians now have 45 days to review and dispute records attributed to them. The review and dispute period is open until May 15, 2017. The review and dispute process is voluntary, but encouraged. The Centers for Medicare and Medicaid Services (CMS) will publish the 2016 payment data, along with updates to the 2013 and 2014 data, on June 30, 2017. Disputes that are initiated before the May 15 deadline will be flagged in the public release on June 30. Under the Sunshine Act, 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. Any payments, ownership interests and other “transfers of value” are reported to CMS for publication in the online database. 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 a number of 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, which will prompt you to enter your user ID and correctly answer all challenge questions. You will then 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. April 19, 2017 General, Managed Care, Medicare Centers for Medicare and Medicaid Services, CMS, Medical Devices, Physician Payments Sunshine Act, Prescription Drugs 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 »
