CMA physician leaders also met with Congress, the president’s Medicare staff at the White House and the new head of the Centers for Medicare and Medicaid Services (CMS), Andy Slavitt, about ICD-10 implementation and the burdensome meaningful use electronic health record program. CMA asked CMS to thoroughly test ICD-10 before implementation and suggested that if the testing shows problems, the program should be delayed. CMA physicians also vigorously urged immediate and sweeping reform to the meaningful use program, with Dr. Cobb telling key decision-makers that while the program was intended to facilitate the exchange of patient information to improve care, it has only hindered participation in the program, imposed unnecessary administrative burdens, disrupted workflow, interfered with patient care and created substantial frustration among physicians. CMA urged decision-makers to require interoperability; align the quality and meaningful use reporting programs; eliminate the all-or-nothing approach, allowing physicians to get credit for the requirements they have met; eliminate the measures that are beyond a physician’s control, such as the patient portal; provide timely feedback; and get rid of the penalties.
Contact: Elizabeth McNeil, email@example.com.
The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for physicians to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year. While the original deadline was February 28, physicians now have until 11:59 p.m., EST, on March 20, 2015, to attest.
Note: The Medicare extension does not affect deadlines for the Medicaid EHR Incentive Program. Additionally, the EHR reporting option for the Physician Quality Reporting System (PQRS) has been extended until March 20, 2015. The California Medical Association will publish more information on the PQRS program extension as it becomes available.
How to Attest
Submit your data to the Registration and Attestation System, which includes 2014 Certified EHR Technology (CEHRT) Flexibility Rule options.
Tips for speed:
Check that your information is up-to-date
Begin entering your 2014 data
Check that your information is up-to-date
Begin entering your 2014 data
To learn more, see the Educational Resources on the CMS EHR Incentive Programs website.
For help, call the EHR Information Center at (888) 734-6433.
Last week the Centers for Medicare and Medicaid Services (CMS) announced it would hold claims for services paid under the 2015 Medicare physician fee schedule due to technical errors discovered after the new fee schedule was published.
Medicare Administrative Contractors (MACs) will hold claims containing 2015 services for the first 14 calendar days of January 2015 (Thursday January 1 through Wednesday January 14) to allow time for CMS to correct the errors.
The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
Claims for services rendered on or before Wednesday December 31, 2014, are unaffected by the 2015 claims hold and will be processed and paid under normal procedures and time frames.
Over the past few years, Congress has created a number of programs that call for payment incentives and reductions (referred to as “adjustments” by the Centers for Medicare and Medicaid Services) that impact physicians and their practices. At their inception, most of these programs offered an incentive to participate. However, most of the programs are entering their penalty phases, with complex and potentially conflicting requirements and implementation processes.
To help physicians understand how these programs will affect their practices, the California Medical Association (CMA) has created a new resource, “Medicare Incentive and Penalty Programs: What physicians need to know.” The resource is available free to CMA members in the resource library at www.cmanet.org/resource-library.
Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key health care provisions in the bill.
In the final hours of the lame duck session, Congress passed a $1.01 trillion spending bill that will keep most of the federal government funded through next September, but it failed to pass a fix for the Medicare sustainable growth rate (SGR). Congress will leave it to be addressed before the April 1 deadline next year, when physicians will be faced with a 21 percent payment cut.
Unfortunately, Congress will begin anew with many new members who have not been a part of the bipartisan, bicameral SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000), which offered a fiscally prudent opportunity for lawmakers to repeal the SGR formula and put Medicare on the path toward a stable, 21st-century program that helps physicians maintain their practices and meets the growing health care needs of the nation’s seniors.
Three committees came to an agreement on reform in 2014, but the new year will bring not only new members, but new committee chairs. However, most of the new committee leadership on both sides of the aisle have said they will likely continue to support the SGR bill.
While Congress’s inability to address this issue once again is frustrating, there continues to be momentum on the SGR. Significant progress is being made on the funding – a point of contention that led to the 17th SGR patch earlier in 2014.
Working to build on the momentum of the Medicare payment policy agreement and the new emerging consensus that the SGR repeal does not need to be offset with other funding, the California Medical Association (CMA) will make Medicare payment reform a major priority again in 2015. However, there will be limited time after the new Congress convenes before the current SGR patch expires on April 1. The House of Representatives is only scheduled to be in session for 37 days before the 21 percent SGR cut takes effect.
CMA leadership will be in Washington, D.C., in February. We will also be asking physicians to meet with their Members of Congress while they are in their home districts in January. And CMA will launch a major physician and patient grassroots campaign. The California Members of Congress need to continue to hear from their physician constituents. We have never been so close to repealing and replacing the SGR, but we must keep the issue on Congress’s front burner. Otherwise, immigration reform, conflicts around the world and budget issues will consume all of their time and attention.
In addition to inaction on SGR, Congress also failed in the lame duck session to extend the Affordable Care Act (ACA) Medicaid (Medi-Cal) primary care rate increase that expires at the end of 2014. We will be pushing Congress to extend this crucial rate increase.
Physicians are hopeful that Congress will build on the progress made this year so that organized medicine can focus on addressing other important health policy issues. Critical health care issues facing Congress next year include the expiring Healthy Families program, graduate medical education, telemedicine and improvements to the ACA.
Contact: Elizabeth McNeil, (800) 786-4262 or firstname.lastname@example.org.
It's that time of year again – time for physicians to decide about their participation in Medicare. Physicians have until Dec. 31, 2014, to make changes to their status for 2015. In addition to the annual threat of steep payment cuts as a result of the sustainable growth rate (SGR) formula, another factor for physicians to consider is that 2015 will be the first year that the Centers for Medicare & Medicaid Services (CMS) will impose penalties under the value-based modifier (VBM) program for large medical groups of 100 or more physicians.
As always, physicians have three choices regarding Medicare: Be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.
The VBM penalties and bonuses will not, however, apply to unassigned claims. That means a nonparticipating physician would not be subject to a VBM penalty. According to CMS, more than 1,000 groups of 100 or more eligible professionals will see payment penalties from the VBM in 2015. Next year will also be the base reporting year for the 2017 penalties imposed on smaller practices.
Other penalties that will be applied in 2015 based on 2013 performance—including those tied to quality reporting, meaningful use and e-prescribing—will decrease the limiting charge amounts that nonparticipating physicians can bill to patients for unassigned claims.
The three participations options are as follows:
Physicians who want to change their participation status for 2015 must send a letter to their Medicare contractor postmarked by December 31, 2014.
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.
Additional information can be found in the American Medical Association (AMA) Medicare Participation Kit. The kit contains a detailed explanation of physician options, a calculator and various sample materials for communicating with patients. The Medicare payment calculator will help you estimate how much your total revenues from Medicare patients would change if you switch your Medicare status from participating to non-participating.
The next SGR Medicare payment cut of ~21 percent is slated to take effect on April 1, 2015, unless Congress passes legislation to stop the cut which they have done 17 times. CMA will be working with AMA to stop the cuts and pass the SGR repeal and Medicare payment reform legislation (HR 4015/S 2000) before April 1.
Contact: Michele Kelly, (213) 226-0338 or email@example.com.