Saturday, February 13, 2016

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Read the latest medical news for the San Bernardino County area.


Deadline to file for meaningful use hardship exemption is March 15

In mid-December, Congress adopted a last-minute bill that gives CMS the authority to grant a blanket exemption for all eligible physicians who apply for the exemption from the 2015 meaningful use penalties. This action prevents the Centers for Medicare and Medicaid Services (CMS) from implementing Medicare payment penalties for physicians who fail to demonstrate meaningful use of a certified electronic health record (EHR) system in 2015.

New rules released last year state that eligible professionals must attest that they met the requirements for stage 2 meaningful use for a period of 90 consecutive days during calendar year 2015. However, CMS did not publish the updated regulations for stage 2 meaningful use until October 16, 2015. As a result, eligible professionals were not able to report until fewer than the 90 required days remained in the calendar year.

CMS had previously stated that it would grant hardship exemptions for 2015 if providers were unable to attest due to the late publishing of the rule, but law at that time only authorized it to grant such exemptions on a case-by-case basis. This new law grants CMS the authority to make an automatic exemption IF it receives a hardship exemption application. It also streamlines the exemption process, alleviating burdensome administrative issues for both physicians and the agency.

Under the new law, physicians are still required to file for a hardship exemption to avoid a payment adjustment for 2015 no later than March 15, 2016.  CMA has just published a new resource titled, "Meaningful Use Hardship Exception Frequently Asked Questions" available FREE for CMA members at www.cmanet.org/ces (top of the page) and is also available in the CMA resource library. The resource is not available to non-members.

Physicians are urged to preemptively file for a 2015 hardship exception to avoid penalties in 2017. Physicians are encouraged to apply even if they are uncertain whether they will meet the program requirements this year. CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the hardship will not prevent a physician from earning an incentive; it simply protects a physician from receiving a meaningful use penalty. Therefore, physicians who believe that they met the meaningful use requirements for the 2015 reporting period should still apply for the hardship protection. Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017.

The application is available on the CMS website and can be downloaded by clicking here. Physicians are encouraged to apply for a hardship under the “EHR Certification/Vendor Issues (CEHRT Issues)” category (option 2.2.d in the application). The American Medical Association (AMA) has published a fact sheet that includes step-by-step instructions on how to apply for the hardship exemption.

The deadlines for submitting applications for hardship exceptions are:

  • Eligible physicians: March 15, 2016
  • Eligible hospitals: April 1, 2016
CMA and AMA worked frantically the last few weeks of 2015 to get the bill passed authorizing this blanket exemption. CMA extends a huge thank you to Majority Leader Kevin McCarthy (R-CA) and Minority Leader Nancy Pelosi (D-CA) for agreeing to keep the House in session and pass the bill on unanimous consent.

For more information on the EHR incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015."


CMS to hold webinars for providers on updates to the Physician Compare website

The Centers for Medicare and Medicaid Services (CMS) will host a series of one-hour webinars about recent updates to the Physician Compare website and future plans for public reporting, including benchmark and star ratings.

The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations, and group practice information.

In 2014, the website also began phasing in physician quality data from the Physician Quality Reporting System, including the Group Practice Reporting Option, the Electronic Prescribing Incentive Program and the Electronic Health Record Meaningful Use Program.

During each webinar, the Physician Compare Support Team will present information and then address participant questions. All sessions will present the same information.

Webinars will be conducted via WebEx at the following times:

  • Tuesday, February 23, 2016, at 9 a.m.
  • Wednesday, February 24, 2016, at 1 p.m.
  • Thursday, February 25, 2016, at 8 a.m.
To register, click here.

For more information about the Physician Compare Initiative, click here.


Noridian posts updated Medicare Physician Fee Schedule

California's Medicare contractor, Noridian, has posted an updated 2016 Medicare Physician Fee Schedule on its website. Last week, Noridian had removed the fee schedule because it contained several technical errors that needed to be fixed.

This update is not expected to cause any delays in reimbursement for physicians, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.

The updated fees are valid for dates of service from January 1 through December 31, 2016.

To see the updated fee schedule, click here.

Contact: Cheryl Bradley, (213) 226-0338 or cbradley@cmanet.org.


AMA publishes guide to physician-focused alternative payment models

The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System).

In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association (AMA) worked with Harold Miller at the Center for Healthcare Quality and Payment Reform to develop a “Guide to Physician-Focused Alternative Payment Models,” which describes seven different APMs that can help physicians in every specialty redesign the way they deliver care in order to improve patient care, manage health care spending and qualify for APM annual bonus payments. The seven APMs include:

  1. Payment for a High-Value Service
  2. Condition-Based Payment for Physician Services
  3. Multi-Physician Bundled Payment
  4. Physician-Facility Procedure Bundle
  5. Warrantied Payment for Physician Services
  6. Episode Payment for a Procedure
  7. Condition-Based Payment

The seven APMs described in the guide have been designed to be able to meet the MACRA eligibility criteria for APMs; however, this will require validation from the Centers for Medicare and Medicaid Services in the future rulemaking process. Under each APM, physicians would take accountability for specific aspects of spending and quality they can control or influence. Physicians will be required to accept some downside financial risk. However, unlike many APMs that have been implemented to date, the physician-focused APMs would not place physicians at financial risk for costs they cannot control.

Importantly, each of the APMs in this report would give participating physicians the resources and flexibility they need to redesign care systems so they can successfully improve care and manage spending for the particular patients, conditions and episodes for which they would be accountable.

In addition to describing the APM designs, the guide also provides examples of how the APMs are being used by different specialties and how they could be applied to diverse patient populations, including cancer care, cardiovascular care, chronic disease management, emergency medicine, gastroenterology, maternity care and surgery.

Click here for more information.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org.


Physicians urged to preemptively file for meaningful use hardship exemptions

Because of a delay in the publication of regulations governing the Medicare meaningful use program, physicians are being urged to preemptively file for a 2015 hardship exemption to avoid penalties in 2016.

Physicians should apply for an exemption under the “extreme and uncontrollable circumstances” category, even if they are uncertain whether they will meet the program requirements this year. Doing so will not preclude physicians from receiving an incentive if they do meet meaningful use requirements, but applying can serve as a safety net in staving off a penalty.

In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use stage 2 for a period of 90 consecutive days during calendar year 2015. Unfortunately, however, the Centers for Medicare and Medicaid Services (CMS) did not publish the updated regulations for stage 2 meaningful use until October 16, 2015. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.

CMS has stated that it will grant hardship exemptions for 2015 if eligible providers are unable to attest due to the late publishing of the rule. However, under current law, CMS can only grant such exemptions on a case-by-case basis. This means that many eligible professions will be required to apply for exemptions and that CMS will have to act on each application individually. CMS has approved over 85 percent of hardship exemptions in the past.

Hardship applications will be available in early 2016 at www.cms.gov/EHRIncentivePrograms.

The California Medical Association (CMA) and the American Medical Association are also supporting new legislation in Congress to streamline the hardship exemption process. The legislation, H.R. 3940 – the Meaningful Use Hardship Relief Act of 2015 – would grant CMS the authority to grant blanket hardship exceptions to physicians, hospitals and other affected providers for 2015, alleviating burdensome administrative issues for both providers and the agency.

CMA will continue to monitor this situation.

For more information on the electronic health record (EHR) incentive program, see the CMS tipsheet, "EHR Incentive Programs for Eligible Professionals: What You Need to Know for 2015."


CMA urgers CMS to implement less burdensome, physician-led MACRA payment models

The California Medical Association (CMA) is urging the Centers for Medicare and Medicaid Services to adopt principles that will assure access to high-quality care for all Medicare patients during the transition to the alternative payment models included in the Medicare payment reform legislation.

In April, President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA), which repeals the badly broken Medicare sustainable growth rate formula and replaces it with new payment systems. After more than a decade of fighting for change by CMA and others in organized medicine, the bill was passed in a monumental bipartisan action taken by Congress.

The MACRA payment models will largely take effect in 2019. It establishes two different payment systems in which physicians can choose to participate. It maintains the existing fee-for-service payment program and streamlines the existing burdensome reporting programs (PQRS, Value Modifier and Meaningful Use) into one new program, the Merit-Based Incentive Program (MIPS).

The MACRA fee-for-service program represents a vast improvement over current law, which no longer provides bonus payments and would have subjected physicians to up to 13 percent in penalties if they fail to meet the reporting requirements. The new program reduces the penalty impact and provides up to 9 percent in quality bonus payments with an additional 10+ percent in bonuses for exceptional performance. The upside potential in the fee-for-service program provides real opportunities for physicians to restore and improve their practices.  

The second payment track allows physicians to participate in alternative payment models that have yet to be defined. MACRA allows physicians to design and develop the models and submit them to CMS. This track will provide an automatic 5 percent bonus payment but requires physicians to accept some financial risk. It also requires physicians to participate in clinical quality improvement activities.

 “We believe that if properly implemented the new physician payment framework has the potential to reduce administrative burdens and promote improvements in the delivery of care for Medicare patients,” CMA wrote in a letter to Andy Slavitt, acting administrator of CMS.

To do this, CMA urged CMS to adopt several guiding principles, including:

Unnecessary administrative burdens in the current reporting programs must be reduced:
CMA urged CMS to aggressively reduce the administrative burdens in the existing fee-for-service reporting programs.   The reporting requirements related to these programs are driving physicians out of the Medicare program and bear little relationship to the realities of medical practice and the delivery of quality care.

New payment models should be physician-led:
MACRA's new alternative payment models should be patient-centric and physician-led. We believe it is imperative for physicians to design and lead new health care delivery and payment models because physicians have the unique training and expertise to manage the provision of quality care.

Alternative models should allow for true innovation:
California physicians and medical groups have led the nation in developing innovative clinical and quality improvement programs and unique health care delivery models. Many of these  models and new ones being developed don’t fit the current landscape of “alternative” payment models. CMA urges CMS to be open to innovation and allow these unique physician models to flourish under the MACRA rules.

Administrative burdens must be reduced:
Administrative burdens must be limited and reporting tasks streamlined so that the delivery of patient-centered care is the principal focus in all clinical settings, particularly small practices.

Total cost of care data must be available to help physicians manage care:
If physicians are going to manage costs and accept some nominal financial risk in the alternative payment models, CMS must provide the appropriate Medicare claims data and share the total cost of care expenditure data (hospital, physician and drugs) so that physicians can appropriately project their costs and manage patient care.

Risk-adjustment methods must recognize diverse patient populations:
California has a diverse patient population, many of whom were uninsured and without appropriate medical care for years before they became eligible for Medicare. It is essential that CMS institute rigorous risk-adjustment related to  severity of illness, stage of disease, genetic factors, local demographics, race, ethnicity and the socioeconomic status of patients.

Payments must continue to be adjusted for geographic differences in practice costs:
Physician payment rates must continue to be adjusted for geographic differences in practice costs. California has eight of the highest cost regions in the country according to CMS data.  Medicare has always adjusted payment rates based on differences in practice costs and we urge this policy to continue. This is essential to ensure all patients have access to care.

CMA is committed to working collaboratively and constructively with CMS and others to develop and share meaningful recommendations as regulations are prepared that will shape the delivery of health care services for years to come.

For more details on the recommended principles, see CMA's letter to CMS.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org.


CMS changes enrollment requirements for Part D prescribers

Beginning on June 1, 2016, all physicians and other providers who prescribe Medicare Part D drugs must be enrolled in Medicare or have a valid record of opting out. Failure to do so will result in a denial of the pharmacy claim or the beneficiary’s request for reimbursement.

The Centers for Medicare and Medicaid Services (CMS) had originally intended to begin enforcing this regulation last June, but the agency delayed implementation to allow sufficient time for beneficiaries and Medicare Part D plans to prepare.

All physicians and other prescribers who are not currently in compliance are encouraged to complete their Medicare enrollment or submit an opt-out affidavit no later than January 1, 2016. This will ensure sufficient processing time so that their Part D patients will continue to have access to necessary medication without interruption.

If you are unsure if you are compliant with this requirement, please review the CMS prescriber enrollment file.

Enrollment applications can be submitted on paper or online via PECOS. To enroll offline using a paper enrollment form, complete the CMS-855O application and mail to Noridian, California's Medicare contractor. Providers should be aware, however, that this form only allows you to enroll in Medicare for the purpose of ordering and certifying services and items, and to prescribe Part D drugs. It will not allow you to bill or be paid for Medicare services. To apply as a Medicare provider with full billing privileges, you will need to complete the appropriate CMS-855 form(s).

For more information, see the CMS Part D Prescriber Enrollment webpage and MLN Matters number SE1434. CMS has also put together a Part D Provider Enrollment FAQ.

For more information on opting out, see the Noridian website.


CMS extends Physician Compare preview period

The Centers for Medicare and Medicaid Services (CMS) has extended the Physician Compare preview to November 16, 2015, to allow more time for physicians to preview their data for the 2014 quality measures that will be reported on the Physician Compare website later this year.

The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital affiliations and group practice information.

In 2014, the website also began phasing in physician quality data from the Physician Quality Reporting System (PQRS), including the Group Practice Reporting Option, the Electronic Prescribing Incentive Program and the Electronic Health Record Meaningful Use Program.

Physicians can access the preview site now via the PQRS portal-Provider Quality Information Portal. To learn more about which measures will be publicly reported and how to preview your measures, visit the Physician Compare Initiative page.

If you have any questions about Physician Compare, public reporting or the 2014 quality measure preview period, please contact CMS at PhysicianCompare@Westat.com.


CMS issues final 2016 Medicare payment rule; includes reimbursement for end-of-life discussions

On Friday, the Centers for Medicare and Medicaid Services (CMS) released the final 2016 Medicare physician fee schedule. One of the biggest changes in the CMS proposal is the assignment of codes to pay physicians for end-of-life consultations.

Key policies finalized in the 2016 payment rule include:

Advanced care planning: The final fee schedule includes two CPT codes to reimburse for advance care planning. Compensating health care professionals for time spent with patients discussing treatment wishes and goals of care is a critical step forward in honoring patient treatment preferences, particularly for those nearing the end of life.

Physician payments: The final rule includes a 0.5 percent overall increase in Medicare reimbursement in 2016 for all providers.

Merit-Based Incentive Payment System: In the final rule, CMS has made changes necessary to begin implementation of the new Merit-Based Incentive Payment System for physicians and other practitioners, which will fully take effect in 2019.

For more information, see the CMS fact sheets.

Click here to view the final rule.


Noridian Medicare announces web-based provider enrollment workshops

Noridian, the Medicare Administrative Contractor for California, announced that it will offer web-based workshops focusing on provider enrollment. These webinars are intended for the Part B provider using the online Provider Enrollment, Chain and Ownership System (PECOS) to change enrollment information, track revalidation or set up a sole proprietorship.

The Internet-based PECOS process can be used in lieu of the Medicare enrollment application (i.e., paper form CMS-855).

The advantages of PECOS are:

  • Faster than paper-based enrollment (45-day processing time in most cases, vs. 60 days for paper)
  • Tailored application process means you only supply information relevant to YOUR application
  • Gives physicians more control over their enrollment information, including reassignments
  • Easy to check and update your information for accuracy
  • Less staff time and administrative costs to complete and submit enrollment to Medicare
There is no registration or teleconference fee. The presentations will be conducted through a web-based training tool that requires an Internet connection and a telephone (toll-free number provided in confirmation email).

For more details and to register, visit https://med.noridianmedicare.com/web/jeb/education/training-events.


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