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

Physician Compare Preview Period open until Aug. 20

July 3, 2020 by

The Physician Compare 60-day Preview Period is officially open as of June 22. You can now preview your 2018 Quality Payment Program performance information before it will appear on Physician Compare profile pages and in the Downloadable Database. You can access the secured Preview through the Quality Payment Program website. Access the resource below on how to preview your data: · Physician Compare Preview Period User Guide For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov. To learn more about the 2018 Quality Payment Program performance information that is available for preview as well as the 2017 clinician utilization data that will be added to the Downloadable Database, download these documents from the Physician Compare Initiative page: · Clinician Performance… . . . read more.

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ENFORCEMENT

Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme

November 18, 2019 by

You know that a branch of lab testing has gone from fad to mainstream when it becomes the subject of a major federal enforcement takedown. Accordingly, the newly announced breakup of a $2.1 billion genetic billing fraud scam, one of the largest Medicare frauds ever undertaken, signifies that genetic testing has officially arrived. Operation Double Helix Known as Operation Double Helix, this landmark investigation and prosecution was a joint HHS, DOJ and FBI crackdown carried out in five federal districts against 35 defendants associated with genetic testing labs (CGx) and telemedicine companies, including doctors, CFOs and CEOs that allegedly “capitalized on the fears of elderly Americans to induce them to sign up for unnecessary or non-existent cancer screening tests,” according to one of the U.S. Attorneys involved. Old Wine in… . . . read more.

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INFORMATION SECURITY

HIPAA enforcement takes a dramatic new direction

November 17, 2019 by

Historically, HIPAA enforcement has focused predominantly on the failure of covered entities to keep protected health information (PHI) private and secure; but now the scope is broadening to encompass keeping PHI too private and too secure. The HHS Office for Civil Rights (OCR), the agency that enforces HIPAA rules, has broken new ground by fining a Florida hospital for failing to provide access to PHI to the individual it relates to. Here’s a look at the case and what it portends about the new direction in HIPAA enforcement. The HIPAA Right of Access When you hear the term “HIPAA Privacy Rule,” the first thing likely to jump into your mind is the obligation to keep PHI secure and refrain from disclosing it to third parties without appropriate authorization. But there’s… . . . read more.

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READER TIPS

Getting that new patient info into EHR before appointment

September 27, 2019 by

Here are some reader tips for getting new patient information into the electronic health records prior to…


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BILLING & COLLECTIONS

CMS releases 2020 Proposed Rule for the Quality Payment Program

September 20, 2019 by

The Centers for Medicare & Medicaid Services (CMS) has released its proposed policies for the 2020 performance year of…


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MEDICARE REIMBURSEMENT

MIPS bonuses are easy to earn—IF you can get into the program

September 20, 2019 by

The Centres for Medicare and Medicaid Services (CMS) has announced the results of…


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INCREASING PROFITS

Deadline to submit a MIPS Targeted Review Request is this month

September 16, 2019 by

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes…


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ENFORCEMENT

Doctors pay $1.1 million to settle genetic test kickback claims

September 6, 2019 by

Kickbacks for genetic test referrals has become a focus of recent federal enforcement action. The most recent case involves…


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CMS UPDATES

Tell your patients about the new eMedicare app launched this year

August 19, 2019 by

Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to…


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