Health care reform – Medical Office Manager

AUTOMATIC PAYMENT

Clinicians in three disaster-struck states get MIPS break

November 27, 2020 by Barb Manning Grimm

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.

TAGGED WITH: disaster, MIPS

CMS

Resource ready for next year’s QRDA Implementation

July 27, 2020 by Barb Manning Grimm

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.

TAGGED WITH: Compliance, Health care reform, MIPS, QRDA

CMS

Physician Compare Preview Period open until Aug. 20

July 3, 2020 by Barb Manning Grimm

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.

TAGGED WITH: CMS, QPP

ENFORCEMENT

Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme

November 18, 2019 by Jared Edis

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.

TAGGED WITH: Billing and collections, Compliance, fraud, Health care reform

INFORMATION SECURITY

HIPAA enforcement takes a dramatic new direction

November 17, 2019 by Barb Manning Grimm

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.

TAGGED WITH: Compliance, Health care reform, HIPAA, Managing patients

READER TIPS