Following a similar initiative on the House side, leaders of the Senate Finance Committee are inviting provider input on Medicare physician payment system reform. Specifically, Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT) are requesting information on: (1) what specific reforms should be made to the physician fee schedule to ensure that physician services are valued appropriately; (2) what specific policies should be implemented that could co-exist with the current physician payment system and would identify and reduce unnecessary utilization to improve health and reduce Medicare spending growth; and (3) within the current fee-for-service system, how can Medicare most effectively incentivize physician practices to undertake the structural, behavioral, and other changes needed to participate in alternative payment models? Additional information, including a full copy of letter from Senators Baucus and Hatch to the health care provider community, is available here. Responses are due by May 31, 2013. The panel also has scheduled a May 14 hearing on "Advancing Reform: Medicare Physicians Payments."
Beginning in July 2013, CMS will be posting downloadable data on from various Medicare.gov Compare websites (Dialysis Facility Compare, Home Health Compare, Hospital Compare, and Nursing Home Compare) at Data.Medicare.Gov. On May 16, 2013, CMS is hosting a webinar to provide an introduction to Data.Medicare.Gov and to demonstrate options for accessing the data. CMS notes that the webinar is aimed at both technical and non-technical users of Compare website data, such as researchers, health care administrators, and quality improvement professionals.
CMS has released a list of teaching hospital “covered recipients” to which payments and other transfers of value must be reported by applicable drug and device manufacturers under the ACA Physician Payment Sunshine Act Final Rule, as discussed in a posting on our Life Sciences Legal Update blog. The posting also discusses industry efforts to obtain CMS clarification on various outstanding questions related to the reporting requirements. In addition, CMS has announced a May 22 National Provider Call on the Sunshine Act reporting requirements, directed to physicians and teaching hospitals and covering the Final Rule, key dates, the role of covered recipients, and resources available to covered recipients.
On April 23, 2013, the Patient-Centered Outcomes Research Institute (PCORI) is hosting a roundtable discussion on “Building a National Data Infrastructure to Advance Patient-Centered Comparative Effectiveness Research.” The event will focus on the challenges and opportunities in creating such a research infrastructure and how PCORI's investments can provide unique value. The registration deadline is April 19, 2013.
On May 3, 2013, CMS and the Office of the National Coordinator for Health Information Technology (ONC) are hosting a meeting to discuss electronic health records, the increase in code levels billed for some Medicare services, and appropriate coding in an increasingly-electronic environment. The meeting, which is aimed at providers, health information technology vendors, and other interested stakeholders, will address issues such as the impact of EHRs on high quality clinical care, provider efficiency and coding, and coding challenges and opportunities facing various groups, including hospitals and clinicians. Attendees may participate in person, via telephone, or web streaming. Registration is required.
On April 24, 2013, CMS is hosting a call to discuss Medicare’s low-volume payment adjustment (LVPA) under the End-Stage Renal Disease (ESRD) prospective payment system. The call will focus on Medicare’s LVPA payment policies, including eligibility requirements and dialysis facility reporting responsibilities. It will also address the findings of a recent GAO report entitled “CMS Should Improve Design and Strengthen Monitoring of Low-Volume Adjustment.”
An April 18, 2013 CMS provider call will focus on the transition to the ICD-10 code set, including implementation planning and preparation strategies.
On April 16, 2013, CMS is holding a National Provider Call on the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) claims-based reporting. The call will provide an overview of reporting requirements and criteria for satisfactorily reporting for Group Practice Reporting Option and Registry.
CMS is hosting two calls in April on the Medicare Shared Savings Program, which in intended to help providers participate in Accountable Care Organizations (ACOs) in order to improve quality of care for Medicare patients. First, an April 9, 2013 call will focus on preparing for the Shared Savings Program application process for the January 1, 2014 start date. Second, an April 23 call will cover tips for completing a successful ACO application.
Effective May 1, 2013, Medicare contractors will activate edits that will deny claims for Medicare Part B (including imaging and lab services), DME, and Part A home health agency (HHA) services if the ordering/referring physician or other professional is not identified, is not in Medicare's enrollment records, or is not of a specialty type that may order/refer the service/item being billed. Concerns have been raised by physicians and suppliers that they could experience claims denials and delays after May 1 based on discrepancies between the names of the ordering physician on the 1500 claim form and in Medicare’s enrollment records. CMS is holding a March 20, 2013 National Provider Call to discuss these new requirements.
CMS is hosting a call on March 19, 2013 to discuss the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) claims-based reporting. The call will provide an overview of how to report for PQRS and eRx through claims, including how to start reporting, 2013 reporting periods and frequency, coding/measure specification, and tips for satisfactorily reporting.
On March 13, 2013, CMS is hosting a provider call on the Medicare End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year (PY) 2015. Among other things, the call will review the measures, standards, scoring methodology, and payment reduction scale that will be applied to the PY 2015 program.
On March 14, 2013, CMS is hosting a National Provider Call to provide an overview of the FY 2015 Medicare Hospital Value-Based Purchasing (VBP) Program design and a preview of the FY 2015 Baseline Measures Report. The event is intended to help demonstrate how hospitals will be evaluated for each of the FY 2015 domains (measures/dimensions).
CMS is holding series of meetings in May and June 2013 to discuss preliminary determinations for applications for new Healthcare Common Procedure Coding System (HCPCS) codes for the 2014 update. The following are the 2013 public meeting dates:
- May 8 and 9, 2013 -- Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents
- May 29, 2013 -- Supplies and Other
- June 4, 2013 -- Durable Medical Equipment and Accessories & Orthotics and Prosthetics
Draft agendas, including a summary of each request and CMS’s preliminary decision, are expected to be posted on the HCPCS web site at least 4 weeks before each meeting.
This post was written by Nancy Sheliga.
On March 5, 2013, the ICD-9-CM Coordination and Maintenance Committee is holding a public forum to discuss proposed code changes to the ICD-9-CM and ICD-10-CM/PCS code sets. As previously reported, CMS has scheduled implementation of the ICD-10-CM/ICD-10-PCS code sets for October 1, 2014. Accordingly, only limited code updates to capture new technologies and diseases will be considered to the ICD-9-CM and ICD-10 code sets during the March 5th meeting (regular updates to ICD-10 are scheduled to begin October 1, 2015). Both procedure and diagnosis code issues will be reviewed at the meeting. The meeting will be held at CMS headquarters in Baltimore, with phone conference lines and webcast broadcasting also expected to be available. Registration will close on February 22 or when the auditorium’s seating limit has been reached, whichever comes first.
On February 19, 2013, CMS is hosting a national provider call on the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program, focusing on how to avoid the 2014 eRx and 2015 PQRS payment adjustment.
CMS is hosting the next semi-annual meeting of the Advisory Panel on Hospital Outpatient Payment for 2013 on March 11, 2013. The purpose of the Panel is to advise the HHS Secretary and the CMS Administrator on the clinical integrity of ambulatory payment classification groups and their associated weights, and hospital outpatient therapeutic supervision issues. The deadline for presentations and comments is January 25, 2013, and the hardcopy of the presentation must be received by February 1, 2013. The meeting registration deadline is February 22, 2013.
** Note that due to an “unexpected low response to requests for presentations,” CMS has cancelled the previously-scheduled March 12 session, and the meeting will not be onsite at CMS headquarters; it will be conducted electronically via webcast, teleconference, and/or webinar.
On January 24, 2013, CMS is hosting a Special Open Door Forum on “Future Development of the Quality Improvement Organization (QIO) Program.” The call will address ways that QIOs, in partnership with CMS, can: maximize learning and collaboration in healthcare quality improvement and value with local, state, and regional organizations; demonstrate value to beneficiaries, patients, and taxpayers; support the spread of new models of care; and help achieve the goals of the National Quality Strategy.
On January 31, 2013, CMS is hosting a call on its National Partnership to Improve Dementia Care in Nursing Homes. The partnership is focused on improving dementia care through the use of individualized, person-centered care approaches, which CMS hopes will reduce the use of unnecessary antipsychotic medications in nursing homes and eventually other care settings. The CMS call will provide information on the goals of the national partnership, quality measures, and ongoing outreach efforts. The target audience for the call includes consumer and advocacy groups, nursing home providers, surveyors, prescribers, professional associations, and other interested stakeholders. Registration is required to participate in the call.
CMS is hosting a national provider call on January 16, 2013 on Meaningful Use requirements under the Medicare and Medicaid Electronic Health Record Incentive Programs. The target audience is hospitals, critical access hospitals, and professionals eligible for incentives. Registration is required.