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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 ...

California to begin receiving new Medicare cards in May

The Centers for Medicare and Medicaid Services (CMS) began mailing new identification cards to Medicare beneficiaries this month, as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new cards contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number that will replace the current SSN-based Health Insurance Claim Number (HICN). The new MBI will also be used for Medicare transactions like billing, and eligibility and claim status checks. The first wave of cards mailed this month will be to newly-enrolled Medicare beneficiaries. Beginning in May ...

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 ...

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 ...

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 ...

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 ...

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 ...

Meaningful use reporting deadline pushed back two weeks to March 13

The Centers for Medicare & Medicaid Services (CMS) on Monday announced that physicians would have two additional weeks to register and attest to meaningful use for 2016 and avoid the 2018 penalty. Physicians now have until Monday, March 13, to attest for the 2016 reporting year. Two weeks ago, hospitals also received a similar reprieve. Physicians should note that CMS is only extending the attestation period, not the reporting period, so physicians must have concluded their reporting by December 31, 2016. Although the Medicare meaningful use program is being phased out ...

2017 Medicare EHR payment adjustment reconsideration forms due February 28

Eligible physicians who have been identified as being subject to Medicare electronic health record (EHR) payment penalties in 2017 (based on the 2015 reporting period), and believe that determination to be in error, have until February 28, 2017, to submit a reconsideration form to the Centers for Medicare and Medicaid Services (CMS). The reconsideration form can be downloaded from the CMS website. For reconsideration instructions, click here. If you have questions about the reconsideration process, please email pareconsideration@provider-resources.com. For more information on payment adjustments and hardship applications, or for information ...

Are you exempt from ICD-10 PQRS penalties in 2016?

On October 1, 2016, new ICD-10 code sets went into effect that will impact the ability of the Centers for Medicare and Medicaid Services (CMS) to process data reported on certain quality measures for the fourth quarter of 2016. Because of this, CMS announced that it will waive 2017 or 2018 Physician Quality Reporting System (PQRS) payment adjustments, if applicable, for any physician or group practice that fails to satisfactorily report for 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for ...