Archive for: CMS

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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: MIPS

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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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: MIPS

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: MIPS

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: MIPS

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: MIPS

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: MIPS

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: Advanced APMs

CMS Announces Participants in BPCI Advanced and Releases Evaluation Report for BPCI Initiative

CMS announces BPCI participants and releases its 5th evaluation report on the initiative.

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Payment Innovation: MIPS

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: MIPS

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: MIPS

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: MIPS

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: MIPS

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: MIPS

UPDATED: CMS Announces “Slight” Adjustments to 2017 Final MIPS Scores

CMS announces “slight” adjustments to some 2017 MIPS final scores.

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Payment Innovation: MIPS

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: MIPS

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: MIPS

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: MIPS

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: Advanced APMs

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: MIPS

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: MIPS

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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Health Reform 2.0: 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: MIPS

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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Payment Innovation: PTAC

PTAC Requests Stakeholder Feedback

Comments Requested by September 7, 2018

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Payment Innovation: MIPS

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: MIPS

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: MIPS

CMS Extends Deadline for MIPS Targeted Review to October 1, 2018

MIPS 2017 Performance Feedback Users Guide now available

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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: MIPS

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: Advanced APMs

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: MIPS

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: MIPS

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: Advanced APMs

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: MIPS

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: MIPS

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

Health Reform 2.0: 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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