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You are here: Home / Archives for topics / Health care reform
REIMBURSEMENT

CMS reweighting 2020 MIPS cost performance category

May 20, 2021 by

The Centers for Medicare & Medicaid Services (CMS) recognizes the impact of the COVID-19 pandemic public health emergency (PHE) on clinicians across the country and continues to offer flexibilities to provide relief where possible. Under § 414.1350(d)(3), the Merit-based Incentive Payment System (MIPS) cost performance category weight is 15% of the final score for the 2020 performance period/2022 MIPS payment year. CMS wants all MIPS eligible clinicians to know it is reweighting the cost performance category from 15% to 0% for the 2020 performance period. The 15% cost performance category weight will be redistributed to other performance categories in accordance with § 414.1380(c)(2)(ii)(D). See the table below for reweighting scenarios. Analysis of the underlying data for the 2020 performance year, in comparison to prior years’ data, shows that the volume… . . . read more.

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TOOL

HIPAA compliance checklist

May 14, 2021 by

Having a complete HIPAA compliance program is important to your organization. Run through this HIPAA compliance checklist to see if you have your foundation of HIPAA compliance in place and easily retrievable. HIPAA Policies and Procedures HIPAA privacy policies, procedures, and forms HIPAA security policies, procedures, and forms HIPAA Breach Notification policy and procedure Most recent Notice of Privacy practices Privacy officer’s job responsibilities and contact information Security officer’s job responsibilities and contact information HIPAA workflows and evidence of compliance Most recent HIPAA Risk Analysis Most current HIPAA risk mitigation/risk management documentation Business Associate agreements with list of Business Associates Workforce HIPAA training, periodic HIPAA updates, HIPAA training log Password policies by system Workstation security practices (anti-virus, password requirement, password timeframes, workstation use, etc.) HIPAA documentation specific to the organization… . . . read more.

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COMPLIANCE

OIG sounds the warning on improper COVID-19 vaccination billing

May 2, 2021 by

Providers that furnish COVID-19 vaccination and testing services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic crisis finally tails off. The latest rumblings from the federal enforcement volcano occurred on April 15 when the OIG issued a relatively rare “Message From HHS-OIG Leadership” (Message) to let it be known that the agencies are hearing reports of false billing and “remain vigilant and committed to holding perpetrators of [COVID-19-related] fraud schemes accountable.” Compliance managers at vaccination facilities are well advised to audit whether their organizations are currently meeting the billing and reimbursement rules the Message summarizes. 6 things to check to ensure proper billing of COVID-19 vaccination The Message specifically reminds providers is being provided by… . . . read more.

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MIPS & QPP

Two data deadlines approaching this month

March 19, 2021 by

Two deadlines are coming up for physician practices: The Quality Payment Program Doctors and Clinicians Preview Period will close on March 25. And the data submission period for Merit-based Incentive Payment System eligible clinicians who participated in the 2020 performance year of the Quality Payment Program (QPP) ends March 31. Preview your performance information CMS opened the Doctors and Clinicians Preview Period on Jan. 25, 2021 at 10 a.m. The Preview Period provides an opportunity for doctors and clinicians to review their 2019 Quality Payment Program (QPP) performance information before it is publicly reported on clinician and group profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC). You can access the secured Preview through the QPP website. Here’s where to find guidance on previewing your information: Pre-recorded Presentation: Preview Period: Performance Information for Doctors and… . . . read more.

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CMS

CMS reopens applications for  COVID-19 MIPS Extreme and Uncontrollable Circumstances Policy 

February 25, 2021 by

Centers for Medicare & Medicaid Services continues to offer flexibilities to provide relief to clinicians responding to the 2019 Coronavirus (COVID-19) pandemic. CMS is applying the MIPS automatic extreme and uncontrollable circumstances (EUC) policy to all MIPS eligible clinicians for the 2020 performance period. It is also reopening the MIPS EUC application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31. Applications received between now and March 31, 2021 won’t override previously submitted data for individuals, groups and virtual groups. This listserv will review what these flexibilities mean for: Individual clinicians, groups, and virtual groups that haven’t submitted data; Individual clinicians, groups, and virtual groups that have submitted data; and APM Entities. Individual clinicians, groups, and virtual groups that haven’t submitted data:… . . . read more.

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MIPS

Extreme Circumstances Exception application deadline stretched to Feb. 1

December 9, 2020 by

To support clinicians during the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) is extending the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to Feb. 1, 2021. For the 2020 performance year, CMS will be using its Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency. If your practice has any concerns about the effect of the COVID-19 public health emergency on your performance data, including cost measures, for the 2020 performance period, submit an application now and cite COVID-19 as the reason for your application. If you have an approved application, you can… . . . read more.

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COMPLIANCE

CMS announces historic changes to physician self-referral regs

December 7, 2020 by

CMS has finalized changes to the Physician Self-Referral Law. The law prohibited physicians from making referrals to an entity, for certain health care services, if the physician had a financial relationship with the entity. The Centers for Medicare & Medicaid Services announced the changes to outdated federal regulations it says have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from sending a patient for many types of services to a provider that the physician owns, is employed by, or otherwise receives payment from—regardless of what that payment is for. The old federal regulations that interpret and implement this law were designed for a health care system… . . . read more.

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QPP

2018 performance info now available on Medicare Care Compare and in Provider Data Catalog

December 7, 2020 by

The Centers for Medicare & Medicaid Services (CMS) has added new performance information to the Doctors & Clinicians section of Medicare Care Compare and in the Provider Data Catalog (PDC), the successor websites to Physician Compare and the Physician Compare Downloadable Database. Medicare patients and caregivers can use the Care Compare website to search for and compare doctors, clinicians and groups who are enrolled in Medicare. Publicly reporting 2018 Quality Payment Program performance helps empower patients to select and access the right care from the right provider. Specifically, the 2018 Quality Payment Program performance information on Care Compare clinician and group profile pages includes: 77 MIPS quality measures reported by clinicians and displayed as measure-level star ratings on their profile pages; 84 MIPS quality measures reported by groups and displayed as measure-level star… . . . read more.

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AUTOMATIC PAYMENT

Clinicians in three disaster-struck states get MIPS break

November 27, 2020 by

If your medical practice is located within the disaster-struck states of Louisiana, California or Oregon you may be eligible for a payment adjustment. In response to the Federal Emergency Management Agency (FEMA) designation of Hurricane Laura and the California and Oregon wildfires as national disasters, CMS has determined that the automatic extreme and uncontrollable circumstances policy will be applied to Merit-based Incentive Payment System (MIPS) eligible clinicians in FEMA-identified areas under sections PA-A and PA-B in Louisiana,  California, and Oregon. MIPS eligible clinicians in these areas in 2020 will be automatically identified and receive a neutral payment adjustment for the 2022 MIPS payment year. During the data submission period for the 2020 performance year (Jan. 4, 2021 to March 31, 2021), all four performance categories for these clinicians will be weighted at… . . . read more.

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CMS

Resource ready for next year’s QRDA Implementation

July 27, 2020 by

The Centers for Medicare & Medicaid Services (CMS) has published the Quality Reporting Document Architecture (QRDA) Category III Implementation Guide (IG), Schematron, and Sample Files for Eligible Clinicians and Eligible Professionals Programs. The 2021 CMS QRDA III IG outlines requirements for eligible clinicians and eligible professionals to report electronic clinical quality measures (eCQMs), improvement activities (IA), and promoting interoperability (PI) measures for the calendar year 2021 performance period for these programs: · Quality Payment Program: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) · Comprehensive Primary Care Plus (CPC+) · Primary Care First (PCF) · Medicaid Promoting Interoperability (PI) The 2021 CMS QRDA III IG contains these high-level changes as compared with the 2020 CMS QRDA III IG: · Clarification of CPC+ QRDA III requirements in section 4.1 · Preliminary QRDA… . . . read more.

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