Tag Archives: CMS

May 31 Deadline for 2018 Medicare Shared Savings Program

An organization interested in participating in the Medicare Shared Savings Program (MSSP) as an accountable care organization (ACO) must file a non-binding Notice of Intent to Apply (NOIA) by 12 Noon EDT on Wednesday, May 31, 2017.  Only those organizations that file a NOIA will be permitted to file an MSSP application, which will be … Continue Reading

Participating in the Medicare Shared Savings Program: When and Why

Once a year, the Centers for Medicare & Medicaid Services (CMS) accepts applications for participation in the Medicare Shared Savings Program (MSSP).  On March 22, CMS announced the deadlines for the 2018 application cycle. An organization interested in participating in the MSSP as an accountable care organization (ACO) effective January 1, 2018, must file a … 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

Optimizing Your MIPS Score: Quality Measure Benchmarks and Reporting Mechanisms

The Medicare Quality Payment Program has officially launched, meaning most physicians (and most non-physician practitioners) now are in the initial performance period under the Merit-Based Incentive Payment System (MIPS).  With 60% of the MIPS composite score based on quality measures, the selection of the most appropriate measures, and the manner in which to report, is … 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

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

Top 10 Provisions in the 2016 Medicare Physician Fee Schedule Final Rule

On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) released the 2016 Medicare Physician Fee Schedule Final Rule (Final Rule). Weighing in at 1,358 pages, the Final Rule covers a wide range of subjects, including payment methodologies, advance care planning, and physician value-based purchasing programs. The Final Rule will be published in the Federal Register November 16.… Continue Reading

CMS Fine Tunes Value Modifier as MIPS Prepares to Take the Stage

Since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) became law in April, all talk has been about the new Merit-Based Incentive Payment System (MIPS), which will replace the current Physician Value Modifier Program (VM Program) in 2019. For the next 3 years, however, the VM Program will determine provider payments.… Continue Reading

Mandatory Medicare Bundled Payments: Comprehensive Care for Joint Replacement

The Centers for Medicare & Medicaid Services (CMS) proposes to convert one of the voluntary programs--Bundled Payment for Care Improvement (BPCI)--into a regulatory mandate. Despite the limited evaluative data now available, CMS believes bundled payments hold great promise to improve quality and coordination of care through an entire episode of care.… Continue Reading

Chronic Care Management: Inquiring Minds Want To Know

On February 18, the Centers for Medicare & Medicaid Services (CMS) sponsored a National Provider Call (NPC) on Medicare reimbursement for chronic care management (CCM). The NPC was the first formal presentation CMS has made regarding CCM since it began paying for this service January 1, 2015. In conjunction with the NPC, CMS also released a Medicare Learning Network Fact Sheet on CCM.… Continue Reading

Open Payments Update – Managing Reporting Risks

In the fall of 2014, the Centers for Medicare and Medicaid Services (CMS) launched its Open Payments website, a public, searchable database for information regarding payments made to physicians and teaching hospitals by pharmaceutical companies, medical device manufacturers, and other "applicable manufacturers" in the life sciences.… Continue Reading