Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

MACRA

CMS Misses Chance to Move Physician Pay, QPP to Value, AMGA Says

July 17, 2018 - CMS recently proposed several changes to Medicare physician payments and MACRA’s Quality Payment Program to reduce medical billing and administrative burden. But initial reactions from medical group associations have not been positive. AMGA, formerly the American Medical Group Association, stated that proposed changes are a “missed opportunity to move Medicare provider...


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CMS Proposes 2019 Physician Payment, Quality Payment Program Changes

by Jacqueline LaPointe

CMS recently proposed major changes to Medicare physician payments and the Quality Payment Program to reduce the administrative burden of medical billing. The potential changes in the Medicare Physician Fee Schedule would save individual cl...Additionally, CMS may also start to reimburse clinicians for virtual care under the updated Medicare Physician Fee Schedule. The recently proposed rule would establish reimbursement for virtual check-ins and evaluations of patient-submitted...In the proposed rule, CMS also sought additional stakeholder feedback on a new hospital price transparency requirement. The federal agency is looking for more information on a rule that would require hospitals to make public a list of their...Additionally, the proposed rule would implement changes required under the Bipartisan Budget Act of 2018. Key changes from the act included only applying MIPS payment adjustments to covered professional services under the Physician Fee Sche...

Stakeholders Want Greater MIPS Participation for Higher Rewards

by Jacqueline LaPointe

Policymakers and industry groups are calling on CMS to include more Medicare providers in MACRA’s Merit-Based Incentive Payment System (MIPS). Five members of Congress, all of whom are part of the House GOP Doctors Caucus, recently ur...

EHR Costs, Staffing Still Trouble Small, Rural Practices in MIPS

by Jacqueline LaPointe

Financial challenges plaguing small and rural practices under legacy Medicare value-based purchasing programs are likely to persistent under the Merit-Based Incentive Payment System (MIPS), the Government Accountability Office (GAO) recentl...“Since MIPS uses many of the same reporting and measurement mechanisms as the legacy programs, some stakeholders believe that small and rural practices may be less equipped to manage the administrative, technological, and financial bu...

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans

by Jacqueline LaPointe

CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare Advantage...

Level the Playing Field for Medicare Advantage in MACRA, Orgs Urge

by Jacqueline LaPointe

Eleven industry groups are urging CMS to include Medicare Advantage (MA) in MACRA as soon as possible to provide the same incentives to eligible clinicians in risk-based MA models as those offered to clinicians in Medicare Advanced alternat...

91% of Eligible Clinicians Participated in 2017 MIPS Reporting

by Jacqueline LaPointe

Approximately 91 percent of all eligible clinicians participated in 2017 Merit-Based Incentive Payment System (MIPS) reporting, exceeding the CMS goal of 90 percent participation in the first year of the Quality Payment Program, the federal...The Bipartisan Budget Act of 2018 also granted CMS additional authority to maintain a gradual implementation of the Quality Payment Program, Verma noted. This authority allows the federal agency to further eliminate regulatory burdens in MI...

Provider Orgs Push for 90-Day MIPS Reporting Period in 2018

by Jacqueline LaPointe

Almost 50 provider groups are calling on CMS to reduce the Merit-Based Incentive Payment System (MIPS) reporting period from a full calendar to a minimum of 90 days during the 2018 performance year. Among the groups advocating for increased...

Only 37% of MIPS Quality Measures Deemed Valid by ACP

by Jacqueline LaPointe

The American College of Physicians (ACP) is calling for a “time-out” to assess and improve Merit-Based Incentive Payment System (MIPS) quality measures after finding few of the measures used to determine clinician performance an...

Dissecting Merit-Based Incentive Payment System Reporting

by Jacqueline LaPointe

*UPDATE: CMS extended the MIPS reporting deadline to Tuesday, April 3, 2018, at 8:00 pm EDT, according to an email sent on March 29. Eligible clinicians participating in MACRA’s Merit-Based Incentive Payment System (MIPS) must submit ...CMS noted that geographic location of eligible clinicians is irrelevant as long as the clinicians use the same TIN. Clinicians can switch between reporting as an individual or a group until the March 31 deadline. “Even if you choose o...Similar restrictions exist for clinicians reporting as a group to MIPS. Reporting on Quality, Improvement Activities and Advancing Care Information MIPS contains four performance categories: cost, quality, Improvement Activities, and Advanc...For the first MIPS performance period, eligible clinicians can submit performance data on at least one quality measure to prevent a negative payment adjustment. Although, submitting more performance data could result in positive payment adj...

MIPS Will Impede Value-Based Purchasing Transition, MedPAC Argues

by Jacqueline LaPointe

The Medicare Payment Advisory Commission (MedPAC) recently suggested that Congress repeal the Merit-Based Incentive Payment System (MIPS), arguing the new value-based purchasing program “impedes the movement toward high-value care.&rd...

Should Congress Repeal the Merit-Based Incentive Payment System?

by Jacqueline LaPointe

As over 400,000 eligible clinicians prepare to submit data to the Merit-Based Incentive Payment System (MIPS) by the end of March, industry experts are urging policymakers and HHS officials to reconsider and even repeal MACRA’s most p...

Login, Submit Data Early for MIPS Reporting Success, CMS Advises

by Jacqueline LaPointe

Eligible clinicians should log into the reporting system and upload 2017 performance data as soon as possible for Merit-Based Incentive Payment System (MIPS) reporting success, CMS recently suggested in an email. Eligible clinicians reporti...CMS launched the Quality Payment Program data submission feature earlier this year. The feature is a web-based reporting system that allows eligible clinicians to upload and update performance data for MIPS and the Advanced Alternative Paym...

Clinicians, MedPAC Criticize the Quality Payment Program, MIPS

by Jacqueline LaPointe

Almost three-quarters (71 percent) of clinicians are “not very comfortable” or “not comfortable at all” with new measures under MACRA’s Quality Payment Program, and about 62 percent perceive the program’s...The MedPAC analysts suggested a new voluntary value-based reimbursement program to replace MIPS. The Voluntary Value Program would withhold two percent of all Medicare Physician Fee Schedule payments. Clinicians could then choose to join a ...

Voluntary Bundled Payments Launch, HHS Nominee Backs Mandatory APMs

by Jacqueline LaPointe

CMS announced a new voluntary bundled payments opportunity starting in late 2018 on the same day that HHS Secretary nominee Alex Azar seemingly backed mandatory alternative payment models during a Senate Finance committee hearing. The new v...

CMS Releases Quality Payment Program Data Submission System

by Jacqueline LaPointe

Eligible clinicians participating in MACRA’s Quality Payment Program can now start submitting their 2017 performance data on a new system on the program’s website, CMS recently announced in a press release. Medicare clinicians m...For example, CMS designed the Web Interface for groups of 25 or more eligible clinicians that do not plan to report as APM entities. The federal agency advised eligible clinicians to log into the Quality Payment Program data submission syst...

Orgs Argue MIPS Adjustments for Drug Payments Harm Patient Access

by Jacqueline LaPointe

Applying Merit-Based Incentive Payment System (MIPS) adjustments to Medicare Part B drug payments will restrict patient access to critical treatments, 11 medical societies recently told congressional leaders. The medical societies, includin...

OIG: Practice Aid, QPP Integrity Needed for MACRA Implementation

by Jacqueline LaPointe

A recent Office of the Inspector General (OIG) investigation found two major vulnerabilities with MACRA implementation. The HHS watchdog reported that CMS still needs to provide practice-specific technical assistance and implement a Quality...CMS designed the three technical assistance groups to provide specialized, practice-specific assistance. However, only about 25 to 30 percent of QPP-SURS and QIN-QIO efforts were specialized technical assistance focusing on practice-specifi...

Industry Orgs Urge CMS to Lower Risk for MACRA’s Advanced APMs

by Jacqueline LaPointe

Healthcare stakeholders recently encouraged CMS to reconsider the financial risk requirements for Advanced Alternative Payment Models (Advanced APMs), arguing that the risk criteria limit participation in the models. Industry groups, includ...

AMGA Advises CMS on Including MA Models as Advanced APMs by 2018

by Jacqueline LaPointe

CMS can boost participation in Medicare Advantage alternative payment models in 2018 by creating a submission form that allows providers in the models to apply to participate in MACRA’s Advanced Alternative Payment Model (Advanced APM...

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