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CMS identifies and corrects errors in MIPS scoring logic

Centers for Medicare and Medicaid Services (CMS) recently released 2017 Merit-based Incentive Payment System (MIPS) performance scores and payment adjustment information for the 2019 payment year. Physicians have been able to request targeted reviews if they believe an error was made in the calculation of their performance score. The requests CMS received through targeted reviews led them to take a closer look at a few prevailing concerns. Those concerns included the application of the 2017 Advancing Care Information and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity ...

CalHIPSO Webinar: MIPS Reporting for 2018

The Health Services Advisory Group and the California Health Information Partnership & Services Organization (CalHIPSO) is hosting a free educational webinar on Thursday, October 4, 2018, on the Medicare Merit-Based Incentive Payment System (MIPS). This webinar will cover what you and your practice need to know as you look forward to MIPS reporting for the 2018 performance year. There are many factors to consider that effect your scores. The 2018 reporting year is very similar to 2017, with slightly higher thresholds and benchmarks. The webinar will explore various scenarios and ...

CMA calls on CMS to reverse step therapy decision

The California Medical Association (CMA) and an American Medical Association (AMA)-led coalition of 94 medical societies delivered a letter to the Centers for Medicare and Medicaid Services (CMS) about the serious concerns physicians have with the agency’s recent decision to allow Medicare Advantage plans to use step therapy for Part B drugs.  The letter calls on CMS to reinstate its 2012 policy prohibiting Medicare Advantage plans from utilizing step therapy protocols for Part B physician administered medications. The growing burdens generated by step therapy and prior authorization programs create a ...

CMA and AMA oppose CMS proposal to collapse E/M codes

More than 150 health care organizations, including the California Medical Association (CMA) and the American Medical Association (AMA), sent a joint letter to the Centers for Medicare and Medicaid Services (CMS), opposing the agency’s proposal to collapse evaluation and management (E/M) code and payment levels. The proposal was included in the draft 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule released earlier this summer. CMA and AMA appreciate CMS’s genuine desire to reduce documentation burdens on physicians to allow them to focus on patients over paperwork. Several ...

UnitedHealthcare Community Plan preps for entry into additional Medi-Cal and Medicare Advantage markets

Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products. As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, ...

CMA/AMA responding to proposed Medicare payment rule

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program (QPP) rule. This is the first year that CMS is combining the Medicare fee schedule and QPP rules. There are a number of positive elements in the proposed rule. These include: New payments for physician services that are not part of a face to face office visit (virtual check-ins, remote consults of patient videos and photographs, and online consultations with other physicians) ...

Noridian to present in-person Medicare seminars in Irvine and Sacramento

Noridian, the Medicare administrative contractor for California, has announced several in-person seminars around the state in September. The all-day presentations will be divided into morning and afternoon sessions, including information on the following: Morning Session: 8:30 a.m. to 12 p.m. What's New Preventive Services Telehealth Incident to Services Top A/B Errors Afternoon Session: 1-4:30 p.m. NCDs/LCDs Review Entities Documentation/Signature Requirements Education Corner The seminars are ...

New Medicare ID card mailing completed in California

The Centers for Medicare and Medicaid Services (CMS) recently completed mailing new Medicare ID cards to California beneficiaries. The new Medicare ID cards, required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number, which replaces the previous Social Security-based number. CMS has prepared a “Still Waiting for Your New Card?” handout (in English or Spanish) to provide to patients who did not receive a new Medicare ID card. Patients may be directed to the MyMedicare.gov website or to ...

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 ...

2017 MIPS performance scores and 2019 payment adjustments now available

Physicians can now log in to the Medicare Quality Payment Program (QPP) website to view their final 2017 Merit-based Incentive Payment System (MIPS) performance scores and payment adjustment information for the 2019 payment year. It is important to note the Centers for Medicare and Medicaid Services (CMS) will not be sending out letters this year, so physicians are encouraged to log into the QPP website to learn about any payment adjustments they will receive in 2019. Physicians should be aware that the MIPS payment adjustment is required to be budget neutral. That means ...