Posts Tagged CMS

Medical Association Joins Call to CMS to Delay EHR Certification Requirements

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Medical Association Joins Call to CMS to Delay EHR Certification Requirements

The Medical Association has joined with the American Medical Association and a large number of physician organizations and state medical societies to urge federal health officials to delay 2015 electronic health record certification requirements at least one year to avoid disrupting physician practices citing the limited number of vendors that have fully upgraded their EHR systems to meet the 2015 edition of certified electronic health record technology (CEHRT).

The letter addressed to Patrick Conway, M.D., acting administrator of the Centers for Medicare & Medicaid Services (CMS), and Jon White, M.D., acting national coordinator of the Office of the National Coordinator for Health IT (ONC), highlighted patient safety concerns and overall disruption in physician practices as reasons to delay the certification requirements at least a year.

Just 54 EHR products have been certified to the 2015 standards so far, leaving thousands still awaiting certification. Providers are expected to use EHR technology that meets the updated regulations by January 2018.

“Requiring physicians to upgrade to 2015 Edition technology by 2018 limits choice by forcing physicians to select a system from approximately one percent of existing products,” the letter stated. “In addition, physicians may be driven to switch vendors and utilize a system that is not suitable for their specialty or patient population due to this tight timeline.”

Click here to read the letter.

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CMS Extends Meaningful Use Reporting Deadline to March 13

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CMS Extends Meaningful Use Reporting Deadline to March 13

The Centers for Medicare & Medicaid Services (CMS) has postponed the deadline for the attestation to Meaningful Use by eligible professionals (EPs) participating in the Medicare EHR Incentive Program. The old deadline of Feb. 28 has been postponed to Monday, March 13, 2017, at 11:59 p.m. PT.

If you participate in the Electronic Health Records (EHR) Incentive Program, you must attest to the 2016 program requirements by March 13, 2017, to avoid a 2018 payment adjustment. If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.

Medicare’s EHR Incentive Program, or Meaningful Use, is expected to be phased out for physicians this year, but physicians must still report on the Meaningful Use measures for 2016 to avoid a 3 percent penalty in 2018. CMS expects about 171,000 physicians to be penalized this year for failure to attest to Meaningful Use for 2015.

CMS did not explain why it was pushing back the deadline for 2016 attestation. However, the agency did not specify until November that the reporting period for Meaningful Use was 90 days in 2016, rather than the original full calendar year. No hardship exceptions were granted for 2016 because of the tardy announcement of the reporting period, so it may be possible CMS wants to give EPs every opportunity to attest before the window closes.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate Meaningful Use to avoid the Medicare payment adjustment. You may demonstrate Meaningful Use under either Medicare or Medicaid.

Attestation Resources

Attestation Batch Upload Webpage

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Medicare Releases 2017 Physician Fee Schedule Final Rule

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Medicare Releases 2017 Physician Fee Schedule Final Rule

The Centers for Medicare and Medicaid Services released its final rule for its 2017 physician fee schedule payment policies, which updates payment policies and payment rates for services provided under the Medicare Physician Fee Schedule (PFS) starting Jan 1, 2017.

The 1,400-page 2017 final rule discusses changes to a number of new policies that reflect a broader agencywide strategy to enhance quality, spend smarter and improve Americans’ health.

Here are eight changes to note:

CMS will begin gathering data on postoperative visits. The final rule requires reporting of postoperative visits for high-volume/high-cost procedures by a sample of practitioners in practices with 10 or more physicians. Reporting is required for services related to global procedures provided on or after July 1, 2017.

Changes were made to provider and supplier requirements for Medicare Part C. Providers and suppliers will be screened and enrolled in Medicare to contract with a Medicare Advantage organization to provide items and services to those enrolled in Medicare Advantage health plans.

CMS finalized its proposal to expand eligible telehealth services. The additional codes include those for end-stage renal disease-related dialysis, advanced care planning and critical care consultations. The critical care consultations provided via telehealth will use the new Medicare G-codes.

CMS will improve data transparency. Medicare Advantage organizations use a bidding process to apply to participate in the Medicare Advantage program, and the bidding process will reflect the organization’s estimated costs to provide benefits to enrollees. Under the final rule, Medicare Advantage organizations are required to release data associated with these bids on an annual basis. CMS will also require Medicare Advantage organizations and Part D sponsors to release medical loss ratio data on a yearly basis to help beneficiaries make enrollment decisions.

The agency revised the methodology used to calculate geographic practice cost indices. CMS adjusts payments under the physician fee schedule to reflect local differences in practice costs using geographic practice cost indices. The agency will revise the methodology used to calculate GPCIs to increase overall physician fee schedule payments in Puerto Rico. The updates will be phased in over 2017 and 2018.

CMS finalized expansion of the Medicare Diabetes Prevention Program. The 2017 rule finalizes some aspects of the expanded model, but future rulemaking will address payment policies, program safeguards and other issues. CMS expects to begin payment for MDPP services in 2018.

CMS revised the billing codes to more accurately pay for primary care, care management and other cognitive specialties. Among the changes are new codes to pay primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions.

Physician payment rates will increase by 0.24 percent in 2017. CMS arrived at this increase after accounting for a 0.5 percent increase required by the Medicare Access and CHIP Reauthorization Act and mandated budget neutrality cuts, according to the American Hospital Association.

For more information, please see Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year (CY) 2017

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2017 Chronic Care Management Changes and Outsourcing Chronic Care

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2017 Chronic Care Management Changes and Outsourcing Chronic Care

Medicare’s shift towards value-based care means the traditional model of health care reimbursement has just had a major shakeup. With value-based care, providers’ payments are now based on the value of care physicians deliver to patients and their health outcomes.

Patients with chronic conditions often require greater care outside of the office. Beginning Jan. 1, 2015, The Centers for Medicare & Medicaid Services (CMS) began paying for Chronic Care Management (CCM) services. Requiring at least 20 minutes of non-face-to-face care, providers receive an average reimbursement of $42 per patient per month with two or more chronic conditions. CCM has grown in popularity and many providers are seeing the increase in revenue. However, a number of physicians are still struggling to incorporate chronic care management into their practice. While the CMS requirements of CCM may be overwhelming, chances are many physicians are already managing Medicare patients with two or more chronic conditions and not getting the extra reimbursement to help with the added care.

The 2017 Medicare Physician Fee Schedule rule was finalized on Nov. 2, 2016. Providers will see payment changes for care management services in 2017. There are several changes that CMS has proposed regarding chronic care management. These changes are set to make billing rules within CCM simpler as well as expand the payment for complex CCM, including patients with behavioral health conditions. The new fee schedule rule will offer a new set of codes for providing care management to those patients.

Highlights from the 2017 Medicare Physician Fee Schedule regarding CCM

  • Simplification of CCM billing rules
  • Payment for complex CCM patients (CPT code 99487)
  • Supervision requirement change for CCM by Rural Health Clinics (RHC) and Federally Qualified Health Clinics (FQHC)
  • Pay for non-face-to-face extended E & M services

Part of the simplification of the CCM billing rules means the possibility of no longer requiring a consent form from the patient, but rather the provider would simply document in the patient’s medical record that CCM information was provided to the patient. Another benefit of this final rule is that initiating visits no longer have to be face-to-face office visits, unless the patient is considered a new patient or the patient has not been seen within the year prior to commencement of CCM. However, if providers do initiate CCM on a face-to-face visit, they can use the new GPPP7 to bill for that visit and receive a higher payment of $63.68.

Along with these changes to CCM for 2017, there is also a 3.5 percent increase in the CCM payment rate for 2017. The current rate in 2016 for CPT code 99490 is $40.82. This increase would make the 2017 rate $42.21. For complex CCM payments (CPT code 99487), the proposed rate for 2017 is $92.66. The complex CCM, CPT code 99487 requires 60 minutes of non-face-to-face care per month. CMS has also proposed an add-on code for complex CCM (CPT 99489) for each additional 30-minute increments of non-face-to-face time, at a proposed 2017 rate of $46.87. Please note: reimbursement rates vary by region.

MediSYS has outsourced full-service CCM to ease the burden on providers of meeting the CCM requirements while saving providers time and resources to enhance patient care.

“Providers have been very responsive to outsource chronic care management services because of the additional help they receive that saves them time and brings in additional revenue,” explained Jennifer Woodward, director of operations with MediSYS.

Outsourcing your CCM solution can help you increase revenue and expand patient satisfaction as well as provide you better patient access through a broader clinical depiction. CCM will also prepare providers for 2017 and the changes that MACRA has implemented in the healthcare industry to improve patient care and focus on value-based quality goals.

“With MIPS starting next year, providers are working hard to prepare for the changes that coming. By outsourcing this portion of the program, it provides them more time to work on the other aspects of the quality payment program to report effective care coordination,” Woodward said.

For information on MediSYS electronic health records and practice management solutions as well as outsourcing CCM services, please contact MediSYS at sales@medisysinc.com and visit the website at www.medisysinc.com. MediSYS is an official partner with the Medical Association.

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Deadline for Seeking Review of Potential Payment Penalties

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Deadline for Seeking Review of Potential Payment Penalties

Late last month, the Centers for Medicare and Medicaid Services posted information on its website that physicians can consult to determine whether they will be subject to 2017 payment penalties associated with the Physician Quality Reporting System (PQRS) and the Value Modifier. Physician practices that have concerns about the findings in their report(s) have until November 30 to file for an informal review of their data.

These penalties stem from policies in effect prior to the enactment of the Medicare Access and CHIP Reauthorization Act. Failure to successfully complete required PQRS reporting will result in a 2 percent penalty. Value Modifier penalties can range from 1 percent to 4 percent depending on the size of the practice and its performance on cost and quality measures. PQRS penalties will be communicated to physicians by mail as well as in the PQRS feedback reports posted on the CMS website. Value Modifier penalties and bonuses can be found in Quality and Resource Use Reports (QRURs) posted on the website only.

Additional information on accessing the reports and filing for an informal review can be found in the attached documents. Those who have questions, even if they are uncertain about penalty status, are urged to submit a request for informal review. Although in most cases a successful PQRS review will trigger an automatic review of related VM penalties, program officials say the safest course is to file requests for review of both PQRS and VM data.

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

Please see “2015 PQRS: 2017 PQRS Negative Payment Adjustment — Informal Review Made Simple” available on the PQRS Analysis and Payment webpage for more information.

NOTE: The CSP will be unavailable November 18-20 for maintenance.

Additionally, 2015 PQRS feedback reports can be accessed on the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) account. For details on how to obtain your report, please see the “Quick Reference Guide for Accessing 2015 PQRS Feedback Reports.” For information on understanding your report, please see the “2015 PQRS Feedback Report User Guide.” Both guides are on the PQRS Analysis and Payment webpage.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. CT. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in e-mail inquiries to the QualityNet Help Desk.

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