CMA responds to CMS 2015 Medicare fee schedule proposals The California Medical Association (CMA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) commenting on the proposed rules that would impact many aspects of physician payment and federal regulatory programs for 2015. The 39-page letter strongly opposes the agency's plan to accelerate the implementation of the value-based modifier (VBM) payment methodology. CMS has said it will expand the VBM to all physicians in 2017 and increase the potential penalty from 2 percent to 4 percent. CMA also argued that because the agency is ignoring the law that requires CMS to adjust the payment rates for the socioeconomic characteristics of the patients the VBM could discourage physicians from accepting the sickest and poorest patients. The value modifier was enacted by Congress as part of the Affordable Care Act (ACA). A CMA amendment to the law required CMS to risk-adjust the rates, adjust for California’s higher geographic practice costs and certain socioeconomic factors. The VBM is supposed to pay physicians more if they spend less than the national average per patient and successfully report on quality measures. It pays physicians less if they spend more than the national average and do not report on quality. CMA also urged the agency to make revisions to the practice expense relative value units and improvements to the valuation and coding of the global service package. The letter also calls upon CMS to allow physicians to opt-out of Medicare indefinitely rather than every two years, to take CME reporting out of the Physician Payment Sunshine Act, and to scale back the Physician Compare Website until the accuracy of the information can be verified. CMS has also proposed increasing from 3 to 9 the number of quality measures that physicians must report in order to avoid a 2 percent payment penalty under the Physician Quality Reporting System). CMA and AMA oppose the quality measure increase and have asked CMS to stabilize the quality measures so they are not changed on a yearly basis. CMA applauded the expansion of payment for telemedicine services and payment for non-face-to-face visits for managing the care of the chronically ill. More than 2,000 comments were received on the 600-plus-page proposed rule. A final version is expected to be released by Nov. 1. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. September 18, 2014 Medicare Medicare, PQRS, CMS, Physicians Quality Reporting System 0 0 Comment Read More »
PQRS administrative claims-based reporting deadline is October 15 Physicians who do not successfully participate in the Physician Quality Reporting System (PQRS) this year will be subject to PQRS payment penalties starting in 2015. PQRS is a Centers for Medicare and Medicaid Services (CMS) quality reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. Physicians who do not report on at least one individual measure in 2013 or elect to participate in the administrative claims reporting option will receive a 1.5 percent payment penalty in 2015. The penalty goes up to 2 percent in 2016 and beyond. Physicians who successfully report on three individual measures or one measures group will receive a 0.5 percent bonus. Physicians participating in a maintenance-of-certification program are eligible for an extra 0.5 percent bonus, for a total bonus of 1 percent. There are several methods of reporting data: claims-based reporting; registry-based reporting; qualified EHR reporting; and group practice reporting. For more details on each of these methods, see the California Medical Association (CMA) guide, " Getting Started with the Medicare Physician Quality Reporting System," available free to members in the CMA resource library. In 2013 only, CMS has made available the "administrative claims-based reporting mechanism" as an alternative method of avoiding the payment penalty in 2015. Physicians who cannot or choose not to use one of the reporting methods listed above, can sign up for an exemption via the administrative claims-based reporting mechanism before October 15, 2013. Providers who choose the administrative claims-based reporting will be automatically evaluated from claims data on 19 quality measures for 100 percent of their applicable Medicare Part B fee-for-service beneficiaries to whom the measure applies. Physicians must sign-up for this exemption on the CMS Enterprise Portal. The registration site will be available until October 15, 2013. For more information, see CMS's fact sheet, "2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment," which provides additional information on physicians' options for avoiding the payment adjustments in 2015. Contact: Michele Kelly, (213) 226-0338 or mkelly@cmanet.org. September 20, 2013 General Medicare, Physicians Quality Reporting System, PQRS, Centers for Medicare and Medicaid Services, Insurance/Reimbursement 0 0 Comment Read More »
CMA publishes Medicare quality reporting guide The Medicare Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by eligible professionals. Up until now, this program has been voluntary and physicians have received bonuses for participating. That's about to change. Failure to participate now means physicians could face significant penalties in 2015 and beyond. Find out more in CMA's new guide, "Getting Started with the Medicare Physician Quality Reporting System." The guide is avaialble to members only. Contact: CMA's reimbursement help line, (888) 401-5911 or economicservices@cmanet.org. July 25, 2013 Medicare Insurance/Reimbursement, PQRS, Medicare, Physicians Quality Reporting System 0 0 Comment Read More »
