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


. . . read more

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