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Friday Aug 18, 2017

Medicare claim review to become more targeted

The Centers for Medicare & Medicaid Services says it is expanding its medical review strategy, called “Targeted Probe and Educate" later this year. This actually appears to offer some advantages to physicians.


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Posted at 04:14PM Aug 18, 2017 by Kent Moore | Comments[0]

Thursday Aug 10, 2017

MIPS tops list of most burdensome regulations for group practices

physician_MIPS_burden

A new survey of group medical practices shows that while many physicians expect they will be able to meet at least the minimum requirements of the Merit-based Incentive Payment System (MIPS) this year, most see it as a huge burden that affects their ability to care for patients.


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Posted at 04:14PM Aug 10, 2017 by David Twiddy | Comments[0]

Friday Jul 14, 2017

CMS releases physician payment proposals for 2018

The Centers for Medicare & Medicaid Services' proposed rules on the 2018 Medicare physician fee schedule would increase overall rates in 2018 by 0.31 percent.


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Posted at 01:36PM Jul 14, 2017 by Kent Moore | Comments[0]

Monday Jul 03, 2017

CMS expands prior authorization for DME

Prior authorization is the bane of many family physicians’ existence. Despite their pleas for relief, the Centers for Medicare & Medicaid Services (CMS) has announced its intent to expand prior authorization for two pieces of durable medical equipment (DME).


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Posted at 12:24PM Jul 03, 2017 by Kent Moore | Comments[0]

Monday Jun 19, 2017

How to get ready for new Medicare cards

In an attempt to prevent fraud and fight identity theft, Medicare is issuing new identification cards to beneficiaries next year that no longer carry their Social Security numbers. Considering that your practice likely uses these cards to make sure you include the right insurance information and patient identifier on claims, this change will affect you too.


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Posted at 09:53AM Jun 19, 2017 by Kent Moore | Comments[0]

Wednesday May 24, 2017

Medicare to require updated notice of noncoverage form

Family physicians occasionally provide services to Medicare patients for which they expect they will be denied reimbursement because they do not meet Medicare coverage rules. The form used to inform patients of the situation is getting updated.


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Posted at 09:13AM May 24, 2017 by Kent Moore | Comments[0]

Tuesday Dec 20, 2016

2015 quality data now available on Physician Compare website

The Centers for Medicare & Medicaid Services (CMS) this week published quality data for 2015 on the Physician Compare website(www.medicare.gov). The data included selected 2015 Physician Quality Reporting System (PQRS) measures, non-PQRS measures, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures for both individual physicians(www.cms.gov) and group practices or accountable care organizations (ACOs)(www.cms.gov).

Depending on how the data was reported, the newest batch of information includes the following data from 2015:
     •    90 individual clinician-level PQRS measures collected through claims and registry, and 16 non-PQRS measures collected through Qualified Clinical Data Registries (QCDRs) for approximately 175,000 individual clinicians;
     •    91 group practice-level PQRS measures collected via the web interface and registry and eight CAHPS measures for approximately 2,500 group practices
     •    19 Shared Savings Program and Pioneer ACO measures for approximately 400 ACOs.

The release does not include any measures reported by electronic health record for 2015 because that information continues to be plagued by data integrity issues.

Since starting the Physician Compare website in 2010, CMS has continued to enhance the site to provide data that is both useful to consumers and assists them to make informed health care decisions. CMS also believes transparency motivates better physician performance.

Each measure is scored using a star-rating system with each star representing 20 percent of the total score (e.g., five stars is 100 percent, four stars is 80 percent, etc.)

This information is important to physicians because it reflects on their reputation and may influence potential patients to either seek out or avoid a practice. The CMS plans to eventually add information collected under the Medicare Access and CHIPS Reauthorization Act (MACRA) such as data for each of the four Merit-based Incentive Payment System categories (quality, cost, improvement activities, advancing care information) and final scores. Advanced Alternative Payment Model data will also be available, similar to ACO data now.  Item-level benchmarking will be incorporated into the star rating system.

CMS will host webinars on Feb. 21 and 23 about recent updates to Physician Compare. Additional information regarding these events, including registration information, will be available soon. If you have any questions about Physician Compare or the 2015 performance scores release, contact the CMS Physician Compare contractor at PhysicianCompare@Westat.com.

– Sandy Pogones, MPA, CPHQ, Senior Strategist for Health Care Quality for the American Academy of Family Physicians


Posted at 05:15PM Dec 20, 2016 by David Twiddy | Comments[0]

Tuesday Oct 11, 2016

New limited English proficiency rule to start Oct. 17

Sometimes, “getting paid” means implementing regulations as cheaply as possible without running afoul of the law. Such is the case with a federal rule that goes into effect next week.

Beginning Oct. 17, the U.S. Department of Health and Human Services (HHS) will require most physician practices to notify patients with limited English proficiency (LEP) of their freedom from discrimination and of the availability of language assistance services(www.gpo.gov). This rule applies to all health programs or activities that receive funding from or are administered by HHS and the health insurance marketplaces as well as all plans offered by issuers that participate in those marketplaces. For instance, if you receive Medicaid payments or a “meaningful use” incentive payment, this rule applies to you. However, if your practice’s only source of federal funds is through Medicare Part B, then this rule does not apply to you.

To comply with the rule, your practice must ensure “meaningful access” for those with LEP by adhering to the following requirements:

•    You must post a notice of nondiscrimination(www.hhs.gov) in English and may combine the content of the notice with other notices required under other federal laws.
•    You must post taglines(www.hhs.gov) written in the top 15 languages in the state where your practice does business indicating that language assistance is available. HHS has determined the top 15 languages for each state(www.hhs.gov). Ideally, the language of the tagline should be in the language to which it refers; HHS has translated resources (www.hhs.gov)on its website.

You must post the notices in a sufficiently prominent and noticeable place in your office, and the rule requires that you post the language assistance taglines on all “significant publications or communications.” This means items that would result in substantial consequences if the patient did not understand (e.g., notice of a treatment plan or a termination of coverage). If the publication or communication is electronic, it must have a link to the notice of nondiscrimination and 15 taglines on the bottom. If it is paper, the publication must have the statement of nondiscrimination(www.hhs.gov) and taglines, unless it is something small, like a postcard. In those cases, it only needs the statement of nondiscrimination and the tagline in the top two languages. The notice of nondiscrimination and top 15 taglines should also be at the bottom of your website.

If you have not already done so, now would be a good time to develop a plan to address the needs of patients with LEP. Ideally, the plan should include all languages frequently used in the practice, even if they are not included in the top 15 languages in your state. You may also consider signing up with a language assistance call center to help with the translation of documents as well as telephonic or in-person interpretation when needed. For example, some states’ Medicaid programs(www.hca.wa.gov) regard medical interpretation as a covered service and contract with a vendor to provide it. Your local hospital may also have interpreter resources. Finally, you should consider having commonly used documents translated for frequently used languages.

Enforcement of the new rule will fall to HHS’s Office of Civil Rights, which has indicated that it will use a flexible, context-specific analysis to determine any violations on a case-by-case basis. For additional information, check out the HHS summary and fact sheets(www.hhs.gov) and training materials(www.hhs.gov).

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 11:53AM Oct 11, 2016 by David Twiddy | Comments[0]

Wednesday Sep 21, 2016

Codes for smoking and tobacco cessation counseling are changing

As part of its quarterly update(www.cms.gov) to the Medicare physician fee schedule database, the Centers for Medicare & Medicaid Services (CMS) is changing the way you report smoking and tobacco cessation counseling to Medicare.

Effective for services on or after Oct. 1, CMS will no longer consider valid for Medicare purposes CPT codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes).

CMS has advised its Medicare contractors(www.cms.gov) to replace codes G0436 and G0437 with CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes). Additional information on Medicare coverage of such counseling is discussed in Section 210.4.1 of the Medicare National Coverage Determination Manual(www.cms.gov).

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 02:34PM Sep 21, 2016 by David Twiddy | Comments[0]

Friday Sep 09, 2016

CMS will let you pick your pace for MACRA compliance

Apparently acknowledging criticism that the timetable for physicians to participate in the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) next year may be too fast for some, the Centers for Medicare & Medicaid Services (CMS) is giving you some options.

In a blog post this week(blog.cms.gov), Acting CMS Administrator Andy Slavitt laid out the four options, which let physicians and other providers pick the pace of their participation in the first performance period that begins Jan. 1. Choosing one of these options would ensure you do not receive a Medicare payment cut in 2019.

The first option is more of a test of the Quality Payment Program, allowing you to avoid the 2019 payment penalty if you submit at least some data after Jan. 1. The idea is that you will show your system is operating and prepared for broader participation in 2018 and 2019.

The second option is participating for part of 2017 as opposed to an entire calendar year. For example, Slavitt writes, you could submit data for a period starting later and Jan. 1 for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking. and still qualify for a small payment bonus.

If your practice was already expected to be prepared to participate fully in the Quality Payment Program on Jan. 1, you can take option three, which has you submitting a full calendar year of data for the program and qualifying for a modest positive payment adjustment.

The final option is to ignore submitting quality data and other information entirely and join an Advanced Alternative Payment Model in 2017, as provided in MACRA. Physicians who meet the required level of Medicare payments or patients through this alternative model would qualify for a 5 percent incentive payment in 2019.

CMS will provide more details about these options and the Quality Payment Program in general when it releases its final rule on MACRA implementation by Nov. 1. 

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 12:18PM Sep 09, 2016 by David Twiddy | Comments[0]

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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