Archives: Healthcare Reform

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‘WannaCry’— Actions Your Healthcare IT Professional Wants You to Take Now

Thousands of computers across the globe were “held hostage” during the recent WannaCry ransomware attacks that encrypted files on Microsoft Windows operating systems that had not been either patched or upgraded.  The dust has now settled, and what we have learned from those attacks is that they could have been prevented. As a former hospital … Continue Reading

Taking a Closer Look at the MIPS Improvement Activities Component

While the Quality and Advancing Care Information components account for more significant percentages of a provider’s overall Merit-Based Incentive Payment Systems (MIPS) score (60% and 25%, respectively), one also needs to focus on the work required under the Clinical Practice Improvement Activities component, which comprises 15% of the MIPS score. The Centers for Medicare & … Continue Reading

Am I Included in MIPS? New On-Line Lookup Tool

The lookup tool is available on the Quality Payment Program website.  To use it, an individual provider need only enter his or her 10-digit NPI.  The lookup tool then generates a personalized report for the provider, stating whether he or she is excluded from MIPS under the low-volume threshold. Specifically, the report lists each TIN … Continue Reading

Watch Your Mailbox! MIPS Participation Letters Coming Soon!

In early May, each practice enrolled in Medicare Part B  (identified by its Taxpayer Identification Number, or TIN) will receive from its Medicare Administrative Contractor a letter regarding the Merit-Based Incentive Payment System (MIPS) participation status of the TIN and each physician and non-physician practitioner who bills under that TIN (identified by National Provider Identifier, … Continue Reading

MIPS Reporting: Getting Off on the Right Foot

A physician who did not report performance on quality measures to the Physician Quality Reporting System (PQRS) for 2015 now faces a 6% penalty on all Medicare Part B payments.  The same penalty will apply in 2018 for physicians who do not report performance for 2016. In addition to PQRS penalties, a 3% penalty now … Continue Reading

21st Century Cures Act – Patient Safety Act Protections Extended to HIT Vendors

As we discussed in a previous blog, the 21st Century Cures Act, signed into law December 13, 2016, includes a wide variety of provisions impacting healthcare providers.  One key provision of the Cures Act extends the protections of the 2005 Patient Safety and Quality Improvement Act to health information technology vendors. The Patient Safety Act … Continue Reading

Clock Ticking on New Revenue Opportunity for MSSP ACOs

On December 8, the Center for Medicare and Medicaid Innovation (CMMI) announced two new models to increase patient engagement in care decisions by putting more information in the hands of Medicare beneficiaries. Under one of these models, the Shared Decision Making (SDM) Model, CMMI will pay ACOs participating in the Medicare Shared Savings Program or the … Continue Reading

Key Provisions of the 21st Century Cures Act

With the focus on the future of the Affordable Care Act, the most recently enacted federal healthcare law—the 21st Century Cures Act—is getting less attention than it deserves.  The Cures Act, which weighs in at 312 pages, gained passage in both chambers by wide margins (392-26 in the House, 94-5 in the Senate) and was … Continue Reading

4 Need-To-Know Provisions in the 2017 Medicare Physician Fee Schedule Final Rule

On November 15, CMS published its 393-page 2017 Medicare Physician Fee Schedule Final Rule.  Here are 4 need-to-know provisions likely to have a direct impact on practicing physicians in the upcoming year. 1. Conversion Factor Under the Medicare Access and CHIP Reauthorization Act of 2015, MPFS rates are scheduled to increase by one-half percent each … Continue Reading

Has the ACA Been Trumped? Only Halfway

Presidential candidate Donald Trump promised that “[o]n day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”[1]   President-elect Trump now has signaled a willingness to retain a few popular provisions (e.g., coverage for pre-existing conditions), but it seems likely Obamacare will be replaced with some form of … Continue Reading

Our Top Ten PQRS Reporting Readiness Tips

It has been a busy fall for physicians with the publication of the new Quality Payment Program (QPP) Final Rule and the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, the release of the 2016 Quality Resource Utilization Reports (QRURs), and the announcement of the Physician Compare preview period.  In addition, many physicians now are … Continue Reading

Medicare Advantage “Shopping Season”

The annual enrollment period (AEP) for Medicare beneficiaries to “shop” for their Medicare Advantage plan officially began October 15, 2016, and will end December 7, 2016.  This 54-day shopping season can be filled with anxiety, and many Medicare beneficiaries turn to their providers for input as a result.  Providers can help their patients in several … Continue Reading

MIPS Final Rule: Who’s In, Who’s Out, and Who Cares?

On October 14, 2016, the Centers for Medicare & Medicaid Services (CMS) published its final rule implementing the new Medicare Quality Payment Program, including the Merit-Based Incentive Payment System, or MIPS.  In response to providers’ concerns, CMS has made significant modifications to the proposed rule to ease program implementation.  Specifically, CMS has made four key … Continue Reading

MIPS Pick Your Pace: What Will You Choose to Do?

In response to complaints that the planned January 1, 2017, launch date for the new Medicare Merit-Based Incentive Payment Program (MIPS) is too much too fast, CMS Acting Administrator Andy Slavitt announced in a September 8 blog post the “Pick Your Pace” opportunity. According to Mr. Slavitt, MIPS-eligible clinicians – including nearly all physicians and … Continue Reading

Ambulatory Care Management Programs: New Revenue Opportunity for Specialists

Ambulatory care management programs generally are viewed as services offered by primary care providers.  However, specialists – oncologists, urologists, rheumatologists, cardiologists, pulmonologists, to name a few – caring for patients with chronic conditions should evaluate this opportunity. By providing patient education, performing medication reconciliation, and arranging for support services, clinical staff bring care outside the … Continue Reading

2017 Medicare Physician Fee Schedule Proposed Rule: Expanded Payments for Care Management Services

Since 2013, the Centers for Medicare & Medicaid Services (CMS) has been expanding Medicare payments for care management services.  This trend continues in the 2017 Medicare Physician Fee Schedule Proposed Rule.  Specifically, CMS proposes the following: Simplify the chronic care management (CCM) billing rules. Pay for complex CCM. Pay for care plan development. Pay for … Continue Reading

Medicare’s Proposed Episode Payment Model: 6 Things to Know Now as You Prepare for Later

On August 2, the Centers for Medicare & Medicaid Services (CMS) published a 248-page proposed rule detailing a new mandatory bundled payment program for heart attacks and bypass surgery. Like CMS’ current mandatory bundled payment program, Comprehensive Care for Joint Replacement (CJR), the proposed Episode Payment Model (EPM) will make hospitals in select cities responsible … Continue Reading

MACRA Delay? Don’t Count On It

You may have seen a headline or two last week stating that the Centers for Medicare & Medicaid Services (CMS) may delay MACRA’s effective date.  However, the agency has not announced any such delay.  Instead, CMS’ top official indicated the agency is considering some adjustments to the initial performance period. The U.S. Senate Finance Committee … Continue Reading

2017 OPPS Proposed Rule: 4 Things to Know and 4 Things to Think About Regarding Site-Neutral Payments

The recently published 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule provides additional information regarding the site-neutral payment provisions included in Section 603 of the Bipartisan Budget Act of 2015. The Proposed Rule explains certain aspects of the provisions that will prohibit newly established off-campus hospital outpatient departments (HOPDs) from billing services and receiving payments … Continue Reading

MIPS Proposed Rule: Big Changes to Medicare Physician Payments Starting in 2017

Good news:  2016 is the last year physicians have to report performance measure scores to the Centers for Medicare & Medicaid Services (CMS) to avoid up to a 9% reduction in Medicare Physician Fee Schedule (MPFS) payments under the Physician Quality Reporting System (PQRS), the Value-Based Modifier Program, and the Meaningful Use Program. Not-so-good-news:  A … Continue Reading

2016 Medicare Physician Value Modifier Results – More of the Same

What Happened in 2016? The Centers for Medicare & Medicaid Services (CMS) has now released the official results for the second year of the Medicare Physician Value Modifier Program (VM Program).  Groups of 10 or more eligible professionals (EPs) are subject to adjustments in their 2016 Medicare Physician Fee Schedule payments based on their 2014 … Continue Reading
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