Archive for: CMS

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Diagnostics: Other

CMS Releases Full Agenda for June 24 CLFS Public Meeting

On June 20, CMS released the full agenda for the annual public CLFS meeting.

EXTERNAL LINK

Diagnostics: Other

CMS Posts Agenda for June 24 CLFS Annual Public Meeting

On June 7, CMS posted the agenda for the annual public CLFS meeting.

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Payment Innovation: PTAC

PTAC Calls on CMS for More Comprehensive Approach to Wound Care Delivery

The PTAC report concludes that a more comprehensive approach to wound care is needed.

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Prescription Drug: Regulation

CMS Releases Final Part D Rule

On May 16, 2018, CMS released the final Part D and Medicare Advantage rule aimed at lowering drug prices.

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Payment Innovation: Quality Payment Program

CMS Holds Webinar on Advanced APMs on May 9

CMS will hold a webinar on May 9 to provide an overview of Advanced APMs.

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Payment Innovation: Innovation Center

CMS Presents Primary Care First and Direct Contracting Informational Sessions

CMS and CMMI will hold informational sessions on recently announced payment models. CMS announced two new pathways encompassing five new payment models intended to move organizations toward value based payments and away from fee-for-service.

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Payment Innovation: Innovation Center

BPCI Advanced Second Cohort Application Period Started

On October 1, 2018, the first cohort of Participants in the BPCI Advanced Model started participation in CMMI’s Advanced Alternative Payment model. CMS announced the second application period for BPCI Advanced on April 24, 2019.

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Payment Innovation: Other

CMS Issues Final Rule for the 2020 Annual Notice of Benefit and Payment Parameters

CMs released the final rule for the 2020 annual Notice of Benefit and Payment Parameters.

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Payment Innovation: Other

Quality Proposals from IRF, IPF and Hospice FY 2020 Payment Rules

CMS released proposed regulations for FY 2020 Medicare payment for IRF, IPF and Hospice.

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Payment Innovation: Other

Quality and Safety of Nursing Home Care Under Scrutiny

The quality and beneficiary safety of nursing home care is under scrutiny.

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Payment Innovation: Innovation Center

CMS Releases ACO Care Coordination Toolkit

CMS released a public ACO Care Coordination Toolkit and case studies series.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS uploaded new resources to the Quality Payment Program Resource Library.

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Payment Innovation: Quality Payment Program

Upcoming Webinar on MIPS APM Scoring Standards on April 24

CMS is hosting a webinar on April 24 on the MIPS APM scoring standards.

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Diagnostics: Other

CMS Releases List of New CLIA-Waived Tests

CMS releases list of 12 new CLIA-waived tests

EXTERNAL LINK

Payment Innovation: Other

CMS Podcast on 2019 Quality Conference Now Available

CMS posted a podcast episode on the 2019 Quality Conference.

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Payment Innovation: Quality Payment Program

CMS Opens Web Interface and CAHPS Survey Registration

CMS opens CMS Web Interface registration and the CAHPS for MIPS survey for 2019.

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Payment Innovation: Quality Payment Program

Upcoming CMS MIPS Webinars on Facility-based Measurement and the PI Performance Category

CMS is holding two webinars on facility-based measurement and the PI performance category for MIPS.

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Insurance Coverage: Regulation

Utah Medicaid 1115 Waiver Summary

On June 22, 2018, Utah submitted an 1115 waiver amendment to CMS seeking to implement a partial and capped Medicaid expansion, as well as Medicaid work requirements for certain populations. Following that waiver amendment, on February 6, 2019, Utah submitted an additional 1115 waiver amendment lifting the Medicaid Institution for Mental Disease (IMD) exclusion for…

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Payment Innovation: Innovation Center

BPCI Update: Second Cohort Application Period to Start in April, CMS Announces Participants Leaving First Cohort

The second cohort application period for BPCI to start in April 2019 while CMS announces 252 participants from the first cohort leave program.

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Payment Innovation: Other

CMS Releases Medicare Advantage Final Rate Notice and Call Letter

CMS released the final Rate Notice and Call Letter for Medicare Advantage.

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Payment Innovation: Other

CMS Announces Artificial Intelligence Health Outcomes Challenge

CMS announces the Artificial Intelligence Health Outcomes Challenge.

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Payment Innovation: Other

CMS is Now Accepting Proposals for New Measures for the Medicare Promoting Interoperability Program

The CMS Annual Call for Measures for the Medicare Promoting Interoperability Program is now open.

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Prescription Drug: Regulation

CMS Issues Pair of Rules on Line Item Extension Drugs

CMS issues pair of final rules addressing line item extension drugs.

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Insurance Coverage: Original Analysis

Ohio Section 1115 Waiver Approval

On March 15, 2019, CMS approved Ohio’s Medicaid 1115 waiver, allowing the state to implement work requirements for certain Medicaid recipients.

ORIGINAL ANALYSIS

Payment Innovation: Other

CMS Retires PQRS Website

CMS will retire the PQRS program website.

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Payment Innovation: Other

CMS Publishes Guidance on 1115 Waiver Evaluations

CMS published guidance for states on 1115 waiver evaluations.

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Payment Innovation: Other

CMS Updates Drug Spending Dashboards

CMS updated its drug spending dashboards with 2017 data.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS has updated its QPP Resource Library.

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Payment Innovation: Quality Payment Program

REMINDER: April 2, 2019, 8 pm ET, is the 2018 MIPS Data Submission Deadline

April 2, 2019, 8 pm ET, is the 2018 MIPS Data Submission Deadline.

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Prescription Drug: Other

Members Send Letter to HHS Opposing Changes to Protected Classes

On March 13, 2019, more than 70 members joined Representatives Barbara Lee (D-CA) and Will Hurd (R-TX) in sending a letter to Secretary and of Health and Human Services Alex Azar expressing opposition to the CMS proposed rule changing the six protected classes of drugs in Medicare Part D.

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Prescription Drug: Other

CMS Updates Drug Spending Dashboards

CMS updated its drug spending dashboards with data for 2017.

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Insurance Coverage: CMS

Section 1115 Guidance

On March 14th CMS published tools and guidance for states on how to monitor and evaluate 1115 waivers that implement work requirements, require monthly premiums, implement premium assistance programs, waive retroactive eligibility, or implement non-eligibility periods for failing to meet requirements. Additionally, CMS published monitoring and evaluation guidance and tools for states that are implementing…

EXTERNAL LINK

Payment Innovation: Other

CMS Holds Webinar on the Review, Dispute and Correction Periods for Open Payments Program

CMS will present a live Q&A session on March 27, 2019, for Open Payments system users. The session will open with a brief presentation on the review, dispute and correction periods, and the Open Payments team will be available to respond to any questions.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the MIPS Cost Performance Category in 2019

CMS will hold a webinar on March 12, 2019 to provide an overview of the MIPS Cost performance category of the in 2019 (Year 3).

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Payment Innovation: Quality Payment Program

CMS Seeks Nominations of Clinical Experts for Subcommittees Developing Cost Measures

CMS is accepting nominations until April 12, 2019, of physicians and other practitioners interested in providing clinical input for the development of episode-based cost measures to be used to implement the Cost Performance Category of the Merit-based Incentive Payment System.

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Payment Innovation: Other

CMS Updates Hospital Quality Info and Proposes Changes to Hospital Star Ratings

CMS has updated hospital performance data on the Hospital Compare website and on data.medicare.gov. The update included specific measures of hospitals’ quality of care, many of which are updated quarterly, and the Overall Hospital Star Ratings, which were last updated in December 2017.

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Payment Innovation: Quality Payment Program

Annual Call for MIPS Quality Measures is Open

CMS invites eligible clinicians, professional associations and medical associations to submit MIPS quality measures for consideration for future years.

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on ET3 Model

CMMI will hold a repeat webinar on March 7, 2019, from 2 to 3 pm EST, to provide an overview of the Emergency Triage, Treat and Transport (ET3) Model.

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Payment Innovation: Innovation Center

Year 1 Evaluation of Million Hearts Program Positive but with Substantial Room for Improvement

Launched by the Centers for Medicare and Medicaid Services (CMS) in 2017, the Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model (Million Heart Model) tests whether providing targeted incentives to health care providers to reduce CVD risk lowers the incidence of first-time heart attacks and strokes among Medicare beneficiaries ages 40-79 who have not had…

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Diagnostics: PAMA

CMS Releases Laboratory Data Collection FAQ

CMS has released a new set of frequently asked questions addressing lab data collection.

EXTERNAL LINK

Payment Innovation: Other

CMS Hosts Listening Session on Interoperability and Patient Access Proposed Rule

CMS will host a listening session on the Interoperability and Patient Access Proposed Rule.

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Payment Innovation: Other

CMS Approves Drug Price Negotiations for Colorado Medicaid

Colorado has become the latest state to receive approval from CMS for negotiating drug prices for Medicaid recipients using value-based contracting arrangements.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on New eCQMs Finalized for 2019

CMS will host a webinar titled “Eligible Clinician New eCQMs Finalized for 2019” on March 11, 2019, from 1 to 2 pm EST.

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Payment Innovation: Quality Payment Program

Webinar on CME Counting as MIPS Improvement Activity

CMS and the Accreditation Council for Continuing Medical Education will host a webinar on March 6, 2019, on continuing medical education as MIPS Improvement Activity.

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Payment Innovation: Innovation Center

CMS Hosts Webinar on the VBID and Part D Payment Modernization Model

CMMI will hold a webinar on February 28, 2019, at 3 pm ET. It will provide a deep dive into the application processes and information about model designs for the Part D Payment Modernization Model and the Medicare Advantage Value-Based Insurance Design model for interested Part D sponsors and MA organizations.

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on ET3 Model

CMMI will hold a webinar on February 27, from 1 to 2 pm ET, to provide an overview of the Emergency Triage, Treat and Transport Model. EMS providers, payers, beneficiaries and other interested stakeholders are encouraged to attend.

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Payment Innovation: Other

CMS Launches Podcast

CMS launches “CMS: Beyond the Policy,” a new podcast highlighting updates and changes to policies and programs.

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Payment Innovation: Quality Payment Program

CMS Hosts Two-Part Webinar Series on 2019 QCDR Measure Development and Review Process

CMS is hosting a two-part webinar series to provide information about the 2019 Qualified Clinical Data Registry (QCDR) measures for the Merit-based Incentive Payment System.

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Payment Innovation: Other

Grassley Queries CMS on Update of Recovery of Improper EHR Incentive Payments

In a letter to CMS, Senate Finance Chairman Chuck Grassley (R-IA) pressed the agency for an update on their recovery of improper electronic health record incentive payments.

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MOM Model Application Process

CMMI is holding a webinar on February 21 from 2:00 to 3:15 pm ET to review the Maternal Opioid Misuse (MOM) model Notice of Funding Opportunity and Grants.gov application process.

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Payment Innovation: Other

Bipartisan House and Senate Letters in Support of Medicare Advantage

The House and Senate sent letters to Centers for Medicare and Medicaid Services Administrator Seema Verma in support of the Medicare Advantage program.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Feb 21: Overview of APMs for 2019 Performance Year

CMS will host a webinar on February 21 at 2 pm EST to provide a basic overview of Alternative Payment Models for the 2019 Performance Year of the Quality Payment Program.

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Payment Innovation: Quality Payment Program

CMS Identifies Error in Application of 2019 MIPS Payment Adjustment

CMS discovers an error in the application of the 2019 MIPS payment adjustment where Medicare Administrative Contractors applied the adjustment to Part B drugs.

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Payment Innovation: Innovation Center

Independence at Home: Year Three Evaluation Factsheet Posted

The CMS Innovation Center has posted a factsheet on year three evaluation results for the Independence at Home Demonstration.

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Payment Innovation: Innovation Center

InCK Model: Notice of Funding Opportunity and Webinar on February 19

The CMS Innovation Center has announced a funding opportunity for the Integrated Care for Kids model and a webinar on Feb. 19.

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Payment Innovation: Innovation Center

BPCI Update: Quality Measures Factsheets Now Available

The CMS Innovation Center has posted factsheets for the seven quality measures selected for use in the Bundled Payments for Care Improvement Advanced model.

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Payment Innovation: Innovation Center

Maternal Opioid Misuse Model Funding Opportunity Announced

The CMS Innovation Center will execute up to 12 cooperative agreements with states whose Medicaid agencies will implement the Maternal Opioid Misuse model with one or more “care-delivery partners” in their communities. The Notice of Funding Opportunity is now available.

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Payment Innovation: Innovation Center

CMS Appoints New Senior Medical Advisor for Innovation

CMS has appointed Dr. Anand Shah as the Senior Medical Advisor for Innovation at CMS.

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Payment Innovation: Other

CMS Launches App on What Original Medicare Covers

CMS launches new app called “What’s Covered” that tells users whether Medicare covers a specific medical item or service.

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Payment Innovation: Other

CMS Restarts Open Payment Webinar Series

CMS announces the return of Wednesday Webinars, presented by the Open Payments team.

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Payment Innovation: Innovation Center

McDermottPlus Launches 2019 CMS/CMMI Payment Model Tracker

This handy CMMI payment model tracker will allow you to easily follow changes and help you better understand the evolution of value-based payment in the Medicare and Medicaid program.

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Insurance Coverage: Regulation

Administration Releases Marketplace Proposed Rule

On January 24, 2019, the Centers for Medicare and Medicaid Services issued a proposed rule on payment parameters for the Health Insurance Marketplaces.

EXTERNAL LINK

Diagnostics: Guidance

CMS Holds Informational Call on PAMA Data Collection

CMS hosts informational Open Door Forum to discuss the 2019 PAMA Data Collection process and related requirements.

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Insurance Coverage: Congress

DelBene Leads Letter to CMS to Delay MSSP Application Timeline

On January 23, 2019, Representative Suzan DelBene led a letter to to the Centers for Medicare and Medicaid Services Administrator, Seema Verma, expressing concern related to the deadlines for the Medicare Shared Savings Program.

EXTERNAL LINK

Payment Innovation: Quality Payment Program

Opportunities to Participate in a Technical Expert Panel

CMS has announced opportunities to participate in a Technical Expert Panel. Individuals with expertise in the relevant fields including clinicians, statisticians, quality improvement, methodologists and pertinent measure developers, as well as consumers, are encouraged to submit nominations.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on MIPS for Year 3 of QPP

CMS will host a webinar on January 24, from 1 to 2 pm EST, on the MIPS 2019 Performance Year (Year 3) of the QPP.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS has added additional resources to its QPP Resource Center

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Payment Innovation: Quality Payment Program

CMS Solicits Recommendations on New Measure Sets for MIPS and Comments on Existing Measure Sets

CMS requests recommendations on new measure sets for the quality performance category and/or revisions to existing specialty measure sets for the quality performance category for program year 2020 of the MIPS program. Recommendations will be accepted until the close of business on Monday, February 11, 2019.

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Payment Innovation: Innovation Center

GAO Report Considers Advantages of Voluntary vs Mandatory Payment Models

GAO releases report that identifies the characteristics of model participants and the advantages to using either voluntary or mandatory participants for episode-based payment models.

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Payment Innovation: Innovation Center

CMS Releases Updates to MA VBID Demonstration

CMMI releases updates to the Medicare Advantage Value-Based Insurance Design Demonstration.

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Payment Innovation: Other

MedPAC Scheduled to Discuss MSSP on January 18

MedPAC is scheduled to discuss an analysis of the Medicare Shared Savings Program at their public meeting on January 17-18, 2019.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Eligible Clinician eCQM Diabetes Measures

CMS will host a webinar on January 30 from 12 to 1 pm EST on the Diabetes electronic clinical quality measures.

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Payment Innovation: Quality Payment Program

MIPS 2018 Data Submission Period is Now Open

CMS officially opened the data submission period for MIPS eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources for 2019

CMS has uploaded new resources to the QPP Resource Library for the 2019 Quality Payment Program.

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Payment Innovation: Other

CMS Hosts Webinar on ESRD Quality Incentive Program

CMS will host a webinar on January 15 from 2 to 3 pm ET on the End-Stage Renal Disease Quality Incentive Program.

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Payment Innovation: Other

MSSP Final Rule Seeks to Accelerate Move to Performance-based Risk in Traditional Medicare

CMS published a final rule on December 31, 2018, that overhauls the Medicare Shared Savings Program and takes a new approach to transitioning providers to performance-based risk arrangements in traditional Medicare.

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Diagnostics: Guidance

CMS Publishes CLIA User Fee Update

On December 28, 2018 CMS published its CLIA User Fee Update.

EXTERNAL LINK

Payment Innovation: Regulation

CMS Releases Final Rule Overhauling Medicare ACO Program

CMS has released its final rule redesigning the Medicare Accountable Care Organization Program.

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Payment Innovation: Other

CMS to Create New Office for Regulatory Reform

CMS Administrator Verma announced that the agency will be creating an office for regulatory reform. Once established, the purpose of the office will be to reduce “regulatory burden” for providers and other stakeholders created by CMS programs.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Preventive Care and Screening eCQMs

CMS will host a webinar on Preventive Care and Screening eCQMs on January 15

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Diagnostics: Payment Rates

CMS Releases CY 2019 CLFS Payment Rates

CMS has released the final CY 2019 payment rates for clinical diagnostic services along with supporting instructional materials.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS has added new resources to its QPP Resource Center

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Payment Innovation: Quality Payment Program

Updated List of Advanced APMs Released

CMS HAS recently posted an updated list of Alternative Payment Models.

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Payment Innovation: Other

FY 2019 HVBP Results Released: Most Hospitals Will See Modest Adjustments to their IPPS Payments

CMS released FY 2019 results from the Hospital Value Based Purchasing Program.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS has released MIPS-related QPP resources.

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Payment Innovation: Quality Payment Program

Call for Comments: MIPS Outcome Measures

CMS is soliciting comments on two inpatient quality measures they are adapting for the Merit-based Incentive Payment System. Comments are due Jan 4, 2019.

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Payment Innovation: Quality Payment Program

MIPS Participation Lookup Tool Updated: Final 2018 MIPS Eligibility Status Now Available

Eligible clinicians can check the Quality Payment Program (QPP) Participation Status Tool to view their final 2018 MIPS eligibility status.

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Payment Innovation: Innovation Center

CMS Hosts InCK Model Q&A Session on Dec. 13

CMS will host a Q&A session on the Integrated Care for Kids Model on December 13, 2018 from 3 to 4 pm ET to respond to inquiries about the Model and the upcoming Notice of Funding Opportunity

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Payment Innovation: Other

CMS Proposes Changes for MA and Part D Plans: Coverage Changes for Protected Class Drugs, Step Therapy Requirements and Greater Price Transparency for Medicare Beneficiaries

On November 26, 2018, CMS released a proposed rule that would allow for changes in 2020 to coverage of protected class drugs, establish new requirements for when MA plans may apply step therapy as a utilization management tool for Part B drugs and implement electronic tools to increase drug price transparency for Medicare beneficiaries.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS has updated the QPP resource library.

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Payment Innovation: Other

CMS Hosts Webinars on Clinical Quality Language Basics on Nov. 27 and Nov. 29

CMS will host a webinar on November 27, 2018 from 12 to 1 pm ET introducing the Clinical Quality Language logic expression language.

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Payment Innovation: PTAC

PTAC Update: Preliminary Review Team Reports Released for Dec. 10 Public Meeting

PTAC released Preliminary Review Team  reports for two physician-focused payment model proposals that are on the agenda for the public meeting scheduled for December 10, 2018.

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Payment Innovation: Innovation Center

Innovation Center Posts New Resources

CMS has updated it’s Innovation Center resources.

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Payment Innovation: Quality Payment Program

93% of MIPS Eligible Clinicians Will Receive a Positive MIPS Payment Adjustment in 2019

CMS has announced that 93 percent of MIPS eligible clinicians will receive a positive MIPS payment adjustment in 2019 based on their performance in 2017. Overall, 95 percent of eligible clinicians avoided a negative payment adjustment. The chart below summarizes the results.

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Insurance Coverage: Regulation

Exchange Program Integrity Proposed Rule

The Centers for Medicare and Medicaid Services issued a proposed rule on the Health Insurance Exchanges.

EXTERNAL LINK

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the 2019 Quality Payment Program Final Rule

CMS will host a webinar on Thursday, November 15, 2018 on the 2019 Quality Payment Program Final Rule.

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Payment Innovation: Other

CMS Releases Proposed Rule on Medicare Advantage, Medicare Part D, PAC and Medicaid

CMS releases proposed rule implementing certain provisions of the Bipartisan Budget Act of 2018.  Under this proposed rule, MA plans would be able to offer telehealth benefits beyond what is currently allowable under the traditional Medicare telehealth benefit.

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Payment Innovation: Innovation Center

CMS Announces MOM Model

CMS announces the Material Opioid Misuse (MOM) model as part of the agency’s strategy for combating the opioid crisis.

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Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

CMS has uploaded a number of new resources to the QPP resource center, including web-based training courses.

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Payment Innovation: Quality Payment Program

CMS Extends Cost Measure Field Testing to Nov. 5

CMS is extending the timeframe for submitting feedback on the 2018 field testing of cost measures until Monday, November 5, 2018, at 12:00 pm EDT.

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Payment Innovation: Quality Payment Program

Upcoming QPP Webinars

CMS has scheduled several QPP webinars geared towards Physicians Compare and the CMS Web Interface for ACOs and Groups

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Payment Innovation: Quality Payment Program

CMS Releases Guidance on How 2019 Payment Adjustments Will Be Indicated on Claims

CMS has released guidance to help MIPS eligible clinicians understand how to identify and interpret the application of positive, neutral and/or negative MIPS payment adjustments to be applied to payments for certain claims submitted for services furnished in calendar year 2019 based on clinicians’ 2017 MIPS final scores.

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Payment Innovation: Other

CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

CMS announces a number of changes to the oversight of Medicare Accrediting Organizations. CMS believes these changes will improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

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Payment Innovation: Other

CMS Releases 2019 Medicare Advantage and Part D Prescription Drug Quality Program Star Ratings

CMS has released Part C and Part D Star Ratings; providing information about the quality of plan choices.

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Payment Innovation: Quality Payment Program

Updates to QPP Resource Library

CMS has uploaded a number of new resources to the Quality Payment Program (QPP) Resource Library.

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Payment Innovation: Quality Payment Program

QPP Website Update: 2018 Performance Feedback for MIPS Quality Data Submitted via Claims Now Available

CMS has updated the QPP website so individual eligible clinicians who choose to submit their Quality performance category data via claims can access performance feedback for the 2018 performance year on an ongoing basis.

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Payment Innovation: Quality Payment Program

CMS Announces Field Testing of 13 Cost Measures through October 31, 2018

CMSis conducting field testing for 13 cost measures before consideration of their potential use in the MIPS cost performance category in 2020 or beyond. Note: These are not the same measures currently in use for the 2017 and 2018 MIPS performance periods.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Patient Relationship Categories and Codes

CMS to host webinar on patient relationship categories and codes on Wednesday, October 17, 2018.

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Payment Innovation: Quality Payment Program

Save the Date: Physician Compare National Provider Call

Save the Date: Physician Compare National Provider Call October 3, 2018 1:30 – 3:00 PM ET

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Payment Innovation: Quality Payment Program

QPP Developer Resource: CMS Open Sources Code for Developers that Calculates QPP Quality Measures from Claims Data

CMS open-sources QPP code responsible for calculating quality measures from Medicare claims data submitted by eligible clinicians via Quality Data Codes. This code is intended for developers interested in the calculation mechanism supporting QPP Claims to Quality.

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Payment Innovation: Quality Payment Program

CMS Announces Field Testing of Cost Measures

CMS and its contractor, Acumen, will conduct field testing in October 2018 for 13 cost measures. These measures will be considered for use in the MIPS Cost Performance Category in 2020 or beyond.

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Payment Innovation: Quality Payment Program

Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

Rep. DelBene (D-WA) requests support in asking CMS to adjust the MIPS low-volume threshold in order to include more providers in MIPS as part of the final 2019 physician fee schedule.

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Payment Innovation: Quality Payment Program

MIPS Resource: CMS Posts Infographic on 2019 Payment Adjustments

CMS recently posted an infographic on 2019 MIPS adjustments for the 2017 Performance Year.

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Payment Innovation: Innovation Center

CMS Posts Slides and Recording from Integrated Care for Kids Model Webinar

CMS Innovation Center posts resources from Integrated Care for Kids payment model webinar.

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Payment Innovation: Quality Payment Program

MIPS Resource: CMS Posts Details on Beneficiary Assignment Methodology for Groups and Virtual Groups

CMS recently posted a report that describes the process used by CMS for assigning beneficiaries to a group or a virtual group participating in the Merit-based Incentive Payment System.

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Payment Innovation: Quality Payment Program

CMS Hosts Virtual Office Hours on the 2019 MIPS Performance Period Self-Nomination Process

On September 20, 2018, CMS is hosting a virtual office hours session on the 2019 MIPS self-nomination process.

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Payment Innovation: Quality Payment Program

2018 MIPS Resources for Anesthesiologists, Cardiologists and Radiologists Posted on QPP Resource Center

CMS has posted resource documents on the Merit-based Incentive Payment System (MIPS) for anesthesiologists, cardiologists and radiologists.

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Payment Innovation: Quality Payment Program

CMS Posts 2018 MIPS Data Validation Criteria

CMS posts validation criteria for the 2018 Merit-based Incentive Payment System (MIPS) program.

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Payment Innovation: Quality Payment Program

CMS Releases 2017 MSSP ACO Performance Data

CMS has released a data set showing how Medicare Accountable Care Organizations (ACOs) performed in 2017. 

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Payment Innovation: Quality Payment Program

CMS Hosts 2019 Performance Period MIPS Self-Nomination JIRA Demonstration Webinar on August 30th

CMS is hosting a webinar at 2:00 PM ET on August 30, 2018, on the 2019 Performance Period MIPS self-nomination process.

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Payment Innovation: Quality Payment Program

Call for Nomination: Improvement Activities TEP

CMS has issued a call for nominations for its MIPS Improvement Activities Technical Expert Panel (TEP). CMS is seeking feedback from a group of stakeholders, consumers, patients and experts who can contribute direction and thoughtful input on the improvement activities during development and maintenance.

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Payment Innovation: Innovation Center

CMS Releases Next Gen ACO Model Evaluation

CMS released the first annual report on the Next Generation Accountable Care Organization (ACO) model.  The report provides results from the 18 active Next Gens who participated beginning January 2016.

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Payment Innovation: Innovation Center

CMS Announces Integrated Care for Kids Model to Address the Opioid Crisis

On August 23, 2018, CMS announced a new model that is intended to address the opioid crisis for children.

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Insurance Coverage: Administration

CMS Awards $8.6 Million to Strengthen States Insurance Markets

Administration announces State Flexibility to Stabilize the Market Grant Program which will provide funding to 30 states and the District of Columbia for state exchanges.

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Payment Innovation: Quality Payment Program

CMS Posts Virtual Groups Toolkit for 2019 MIPS Performance Year

CMS hosts virtual group webinar on August 27, 2018 at 2pm ET

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Payment Innovation: Quality Payment Program

CMS Releases First Snapshot of 2018 APM Qualifying Participant and MIPS APM Status

CMS updated the Quality Payment Program Participation Status Tool to include 2018 Advanced Alternative Payment Model Qualifying Participant and Merit-based Incentive Payment System APM status.

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Payment Innovation: Regulation

CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

On August 9th, CMS released the Medicare Shared Savings Program proposed rule.

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Payment Innovation: Quality Payment Program

CMS Opens Application for Medicare Advantage Qualifying Incentive Arrangement Demonstration

CMS is now accepting applications for the Medicare Advantage Qualifying Incentive Arrangement demonstration project under the Medicare Access and CHIP Reauthorization Act Quality Payment Program.

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Payment Innovation: Quality Payment Program

CMS Hosts QPP Conference Calls

The Centers for Medicare & Medicaid Services (CMS) is hosting two Quality Payment Program (QPP)-related conference calls.

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Insurance Coverage: Regulation

Short-term Plans Final Rule

The Centers for Medicare and Medicaid Services issued a final rule on short-term limited duration plans.

EXTERNAL LINK

Payment Innovation: PTAC

PTAC Requests Stakeholder Feedback

Comments Requested by September 7, 2018

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Payment Innovation: Quality Payment Program

CMS Hosting Several MIPS-related Conference Calls

The Centers for Medicare & Medicaid Services (CMS) has announced they are hosting several Merit-based Incentive Payment System (MIPS)-related conference calls.

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Payment Innovation: Other

CMS Administrator Seema Verma Releases Letter to Doctors

Solicits feedback from clinicians on proposal to overhaul E/M documentation, billing and payment

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Payment Innovation: Quality Payment Program

CMS Launches MAQI Demonstration Website

The Centers for Medicare and Medicaid Services (CMS) posted a webpage dedicated to the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration.

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Payment Innovation: Regulation

CMS Releases the CY 2019 PFS Proposed Rule

Includes proposals for physician payment and the Medicare Quality Payment Program

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Payment Innovation: Quality Payment Program

GOP Doctors Caucus Asks CMS to Reduce MIPS Exemptions

On July 3, 2018, five members of the House Republican Doctors Caucus asked CMS Administrator Seema Verma to reduce the number of clinicians excluded from the Merit-Based Incentive Payment System (MIPS) in 2019.

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Payment Innovation: Quality Payment Program

CMS Extends Key BPCI Advanced Deadlines

Submission of signed participation agreements now due August 8, 2018

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Payment Innovation: Quality Payment Program

CMS Advances Medicare Advantage Alternative Payment Model Demonstration

The Centers for Medicare and Medicaid Services (CMS) announced that it is pursuing a demonstration project, the Medicare Advantage Qualifying Payment Arrangement (MAQI) demonstration, which would allow clinicians involved in risk contracts in Medicare Advantage (MA) to be exempt from the Merit-Based Incentive Payment System (MIPS).

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Payment Innovation: Quality Payment Program

GAO Report Considers Small and Rural Practices’ Experiences in MIPS

The Government Accountability Office (GAO) was asked to review certain aspects of small and rural practices participation in legacy incentive programs and the Merit-based Incentive Payment System (MIPS).

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Payment Innovation: Other

CMS Hosts Webinar on Public Reporting on Physician Compare

July 24, 2018 11:00 AM ET/8:00 AM PT and July 26, 2018 3PM ET/12:00 PM PT

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Payment Innovation: Quality Payment Program

QPP Year 1 Update: CMS Informs MIPS Participants of their 2019 Payment Adjustments

The Centers for Medicare & Medicaid Services (CMS) released 2017 Merit-based Incentive Payment System (MIPS) performance feedback.

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Payment Innovation: Quality Payment Program

CMS Announces QCDR Measure Development Google Group and QCDR/Registry Google Calendar

The Centers for Medicare & Medicaid Services (CMS) has created a Qualified Clinical Data Registry (QCDR) Measure Development Google Group and QCDR/Registry Google Calendar.

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Payment Innovation: Quality Payment Program

CMS Hosts Webinar on BPCI Advanced

CMS Hosts Webinar on BPCI Advanced Thursday, June 28, 1 to 2 pm Eastern

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Payment Innovation: Quality Payment Program

CMS Posts Report on MIPS Improvement Activities for Year 1 of the QPP

The Centers for Medicare and Medicaid Services (CMS) released a report on the Improvement Activities (IAs) Performance Category of the Merit-based Incentive Payment System (MIPS) for Year 1 of the Quality Payment Program (QPP).

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Payment Innovation: Quality Payment Program

CMS Finalizes Extreme and Uncontrollable Circumstances Policy for CJR

The Centers for Medicare and Medicaid Services (CMS) published a final rule to provide flexibility to hospital participating in the Comprehensive Care for Joint Replacement (CJR) Model (CJR) located in those areas impacted by extreme and uncontrollable circumstances. 12

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Payment Innovation: Quality Payment Program

Medicare Diabetes Prevention Program Supplier Enrollment Call

On Wednesday, June 20, 2018, the Centers for Medicare & Medicaid Services (CMS), will host a call to present information about the Medicare Diabetes Prevention Program (MDPP) supplier enrollment requirements and process.

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Payment Innovation: Quality Payment Program

Upcoming CMS QPP Webinars

The Centers for Medicare & Medicaid Services (CMS) is hosting a number of webinars on the Quality Payment Program (QPP) this week.

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Payment Innovation: Quality Payment Program

CMS Announces 91% Participation for Year 1 of MIPS

The Centers for Medicare and Medicaid Services (CMS) announced that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP). 

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Payment Innovation: Innovation Center

GAO Report on CMS Innovation Center, Model Implementation and Performance

The Government Accountability Office (GAO) released a report on the Center for Medicare and Medicaid Innovation (Innovation Center) and their work to test payment and delivery options.

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Diagnostics: Litigation

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

On Monday December 11, the American Clinical Laboratory Association (ACLA) filed a legal challenge to CMS’s implementation of the revised Clinical Laboratory Fee Schedule (CLFS) required under Section 216 of the Protecting Access to Medicare Act (PAMA) of 2014.

ORIGINAL ANALYSIS

Insurance Coverage: Regulation

CMS Actuary Report Differs from CBO; 13M Still Uninsured Under AHCA

Today the Centers for Medicare and Medicaid Services’ Office of the Actuary released its report estimating the “financial effect of the ‘American Health Care Act of 2017”, legislation that would repeal and replace portions of the Affordable Care Act.

ORIGINAL ANALYSIS

Diagnostics: PAMA

CMS Releases Reporting Template for PAMA Data Reporting

CMS has released a reporting template to assist laboratories with fee-for-service data collection.

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Payment Innovation: Quality Payment Program

Andy Slavitt Provides Testimony at MACRA Hearing

On May 11, 2016 Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) provided testimony at a hearing on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 held by the Subcommittee on Health of the House Ways and Means Committee.

ORIGINAL ANALYSIS

Payment Innovation: Regulation

Medicare Unveils Plan for New Medicare Physician Payment System

MACRA will impact millions of clinicians across all specialties that provide services to Medicare beneficiaries. This presentation is a guide to understanding the major components of this complex Proposed Rule in a brief and easily understandable format.

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Payment Innovation: Other

ONC Releases RFI on Establishing Metrics to Assess Interoperability

ONC releases RFI regarding Assessing Interoperability for MACRA. Comments are due on June 3, 2016. 

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Payment Innovation: Regulation

MACRA Proposed Rule Posted (Updated)

CMS posted the proposed rule to implement the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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Payment Innovation: Other

CMS Releases RFI on the Implementation of MIPS and the Promotion of Alternative Payments Models

On September 28, 2015, the Centers for Medicare and Medicaid Services (CMS) released Request for Information (RFI) on the Implementation of the Merit-based Incentive Payment System (MIPS), Promotion of Alternative Payment Models (APMs) and Incentive Payments for Participation in Eligible APMs (CMS-3321-NC).

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Diagnostics: Regulation

Breaking: CMS Releases Anticipated PAMA 216 Regulations

The Centers for Medicare and Medicaid Services today posted the long-awaited proposed rule to implement section 216 of the Protecting Access to Medicare Act.

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