Senate Finance Members Seek Physician Input on SGR Reform

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."  

CMS Call on New Medicare Data Portal (May 16)

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 Sunshine Act Update: Covered Teaching Hospitals Listing, Industry Efforts, CMS Provider Call

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.

PCORI Comparative Effectiveness Data Infrastructure Event (April 23)

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.

CMS Meeting on Billing and Coding with Electronic Health Records (May 3)

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.

CMS Call: ESRD Low-Volume Payment Adjustment (April 24)

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.”

CMS Call on Transitioning to ICD-10 in 2013 (April 18)

An April 18, 2013 CMS provider call will focus on the transition to the ICD-10 code set, including implementation planning and preparation strategies. 

CMS Call: PQRS Group Practice Reporting Option and Registry Reporting (April 16).

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 Call on Medicare Shared Savings Program Application Process (April 9 & 23)

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.

Implementation of Medicare Ordering/Referring Provider Edits (March 20 Call)

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 Call: "2013 PQRS and eRx Claims-Based Reporting Made Simple" (March 19)

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.

CMS Call: ESRD Quality Incentive Program (March 13)

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.

National Provider Call: Hospital Value-Based Purchasing FY 2015 Overview (March 14)

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 Announces Dates for 2013 HCPCS Public Meetings

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.

ICD-9-CM Coordination and Maintenance Committee Meeting (March 5, 2013)

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.

CMS Call: How to Avoid a 2014 eRx and 2015 PQRS Payment Adjustment (Feb. 19)

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.

March Meeting of the Advisory Panel on Hospital Outpatient Payment (March 11, 2013)

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.

CMS to Host Call on Future Development of the Quality Improvement Organization (QIO) Program (1/24)

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.

CMS Call to Focus on Improving Dementia Care in Nursing Homes (Jan. 31)

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 Call on Meaningful Use Stage 1 & 2 (Jan. 16)

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. 

Older Entries

January 11, 2013 — Access Board Committee to Meet on ACA Medical Diagnostic Equipment Standards (Jan. 22-23)

January 11, 2013 — FDA To Hold Workshop on Accessible Standardized Medical Device Labeling (April 29-30)

December 14, 2012 — PQRS and eRx Incentive Program National Provider Call (Dec. 18)

December 14, 2012 — CMS Call on ACA Medicare DSH Payment Provisions (Jan. 8, 2013)

December 5, 2012 — House Panel Schedules Hearing on Implementation of ACA's Exchanges and Medicaid Expansion (Dec. 13)

December 3, 2012 — CMS Medicaid Drug Pricing Webinar: Draft Federal Upper Limits and Draft Survey of Retail Prices (Dec. 5)

November 29, 2012 — CMS Schedules Feb. 5 Meeting on FY 2014 IPPS New Tech Add-on Applications

November 28, 2012 — Upcoming FDA Public Meeting: Framework for Pharmacy Compounding/State and Federal Roles (Dec. 19)

November 12, 2012 — MACPAC Meeting on Medicaid Policy Issues (Nov. 15)

November 12, 2012 — Meeting on ACA Medical Diagnostic Equipment Access Standards (Dec. 3-4)

October 31, 2012 — MedPAC Meeting on Medicare Policy Issues (Nov. 1-2)

October 15, 2012 — CMS Calls on IRF, LTCH Quality Reporting (Oct. 18)

October 15, 2012 — CMS Provider Call: PQRS Informal Review (Oct. 23)

October 11, 2012 — OIG to Host "Outlook 2013" Webcast (Oct. 24)

October 10, 2012 — IRS Schedules Hearing on Proposed Rules for Charitable Hospitals (Dec. 5)

October 8, 2012 — CMS Call on Medicare Provider Enrollment (Oct. 10)

September 27, 2012 — FDA Meetings on Patient-Focused Drug Development Initiative

September 25, 2012 — CMS Call: Manual Medical Review of Therapy Claims (Sept. 26)

September 24, 2012 — CMS Call: Preparing Physicians for ICD-10 Implementation (Oct. 25)

September 24, 2012 — CMS Call: Hospital Value-Based Purchasing for FY 2013 (Oct. 4).

September 24, 2012 — National Provider Call: Physician Quality Reporting System and E-Prescribing Incentive Program (Sept. 25)

September 24, 2012 — CMS Call on Medicare Prior Authorization for Power Mobility Devices Demonstration (Sept. 26)

September 24, 2012 — CMS to Host ASC Quality Reporting Webinar (Sept. 26)

September 12, 2012 — CMS Monthly Calls on ACA Provider Issues - Medicaid Expansion Call on Sept. 13

September 5, 2012 — CMS Call: Stage 2 Requirements for the Medicare/Medicaid EHR Incentive Programs (Sept. 13)

September 4, 2012 — PCORI Workshops on Research Topic Selection

September 4, 2012 — MedPAC Meeting on Medicare Policy Issues (Sept. 6-7)

August 31, 2012 — CMS Open Door Forum on Manual Medical Review of Therapy Claims (Sept. 5)

August 16, 2012 — IRS Schedules Nov. 9, 2012 Hearing on ACA Branded Prescription Drug Fee

August 16, 2012 — CMS Call to Focus on ACO Educational Opportunities (Aug. 27)

August 16, 2012 — CMS Forum on LTCH Quality Reporting (Aug. 30)

August 4, 2012 — CMS Announces August 27, 2012 Start Date for Recovery Audit Prepayment Review Demonstration; Provider Call Scheduled for Aug. 9

July 27, 2012 — CMS Provider Call on New Medicare Preventive Services (August 15)

July 25, 2012 — CMS Webinar: State Innovation Models Initiative Overview (July 26)

July 25, 2012 — CMS Call on Medicare Physician Value-Based Payment Modifier (Aug. 1)

July 25, 2012 — CMS Call on Prior Authorization for Power Mobility Devices Demonstration (July 27)

July 25, 2012 — CMS Forum: Improving Care for Medicare Beneficiaries with ESRD (July 31)

July 25, 2012 — CMS Call: Medicare Shared Savings Program and Advance Payment Model Application Process (July 31)

July 25, 2012 — CMS Webinar on Retail Community Pharmacy Consumer Prices Survey (July 26)

July 20, 2012 — CMS Schedules Calls on IRF Quality Reporting Program

June 26, 2012 — CMS Officially Announces Potential Inherent Reasonableness Payment Adjustment for Medicare Retail Diabetic Testing Supplies; Meeting Set for July 23

June 23, 2012 — CMS Webinar on Medicaid National Average Drug Acquisition Cost Survey (June 28)

June 22, 2012 — CMS Call on Medicare Shared Savings Program and Advance Payment Model Application Process (July 16)

June 22, 2012 — National Provider Call: Hospital Value-Based Purchasing (July 11)

June 22, 2012 — CMS/ONC Call: Using Certified EHR Technology to Meet Meaningful Use (June 27)

June 13, 2012 — CMS Call on Prior Authorization for Power Mobility Devices (PMD) Demonstration (June 28)

May 29, 2012 — Hospital Outpatient Payment (HOP) Advisory Panel to Meet Aug. 27-29

May 29, 2012 — CMS Schedules July 16-17 Meetings on 2013 Medicare Clinical Lab Fee Schedule Updates

May 29, 2012 — CMS Call on Medicare & Medicaid EHR Incentive Programs (June 7)

May 23, 2012 — CMS Examining Inherent Reasonableness Payment Adjustment for Medicare Retail Diabetic Testing Supplies; Meeting Scheduled for July 23

May 10, 2012 — CMS Call on IRF PPS Coverage Requirements (May 31)

April 23, 2012 — IRS Notice on ACA Insurance Plans Fees to Fund Patient-Centered Outcomes Research Trust Fund

April 23, 2012 — CMS Call on Power Mobility Device Prior Authorization Demonstration (May 3)

April 23, 2012 — CMS Posts Draft Electronic Clinical Template for Documenting Power Mobility Device (PMD) Encounters

April 19, 2012 — CMS Call on Medicare FFS Implementation of HIPAA Version 5010 and D.0 (April 25)

April 19, 2012 — Safeguarding Health Information: Building Assurance through HIPAA Security Conference (June 6 & 7)

March 26, 2012 — CMS Call on Medicare Preventive Services (March 28)

March 26, 2012 — CMS Call on Medicare & Medicaid EHR Incentive Program Basics (March 29)

March 14, 2012 — FDA Issues Three Draft Guidance Documents on Biosimilar Product Development; Announces May 11 Public Hearing

March 14, 2012 — FDA Public Hearing Regarding Regulation of Clinical Trials (April 23-24)

March 10, 2012 — CMS Calls on Stage 2 Requirements for the Medicare and Medicaid EHR Incentive Programs (March 12 & 27)

March 9, 2012 — MedCAC to Review Coverage with Evidence Development Policy (May 16)

February 24, 2012 — Congressional Health Policy Hearings & Markups

February 24, 2012 — CMS 2012 Public Meetings on HCPCS Applications

February 22, 2012 — Mobile Devices Roundtable: Safeguarding Health Information (March 16)

February 22, 2012 — Physician Value-Based Payment Modifier Program: Experience from Private Sector Physician Pay-for-Performance Programs (Feb. 29)

February 22, 2012 — CMS Call on Prior Authorization for Power Mobility Devices Demonstration (Feb. 23)

February 21, 2012 — Medicare Shared Savings Program and Advance Payment Model Application Process National Provider Call (March 1)

February 13, 2012 — Access Standards Proposed for Medical Diagnostic Equipment under the ACA

February 13, 2012 — CMS Call on Claims-Based Reporting under PQRS, E-Prescribing Program (Feb. 21)

February 10, 2012 — IRS Proposes Regulations to Implement ACA Medical Device Tax

February 10, 2012 — CMS Call on Hospital Value-Based Purchasing Program Performance Reports (Feb. 28)

February 8, 2012 — AHRQ Symposium on Comparative Effectiveness Research (June 12-13)

February 8, 2012 — CMS Call: Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transaction Standards (Feb. 16)

February 8, 2012 — CMS Call on New Medicare Hospital Spending Per Beneficiary Measure (Feb. 9)

January 25, 2012 — E&C Health Subcommittee Plans FDA User Fee Hearings in February

January 23, 2012 — E&C Health Subcommittee Plans FDA User Fee Hearings in February

January 23, 2012 — Medicare Implementation of HIPAA Version 5010 and D.0 Transactions (Jan. 25)

January 23, 2012 — Medicare Shared Savings/ACO Program Webinar (Jan. 31)

December 28, 2011 — CMS Call on Advance Payment ACO Model (Jan. 5)

December 28, 2011 — Advisory Panel on Hospital Outpatient Payment to Meet Feb. 27-29, 2012

December 20, 2011 — CMS Call on Recovery Auditor Prepayment Review Demo (Dec. 21)

December 13, 2011 — FDA Publishes Notice on Biosimilar Biological Product User Fees

December 13, 2011 — MedPAC to Discuss Medicare Payment Policies (Dec. 15 & 16)

December 12, 2011 — CMS Call: Payment Standardization and Risk Adjustment for the Medicare Physician Feedback & Value Modifier Programs (Dec. 21)

December 12, 2011 — Health Care Innovation Challenge Webinars (Dec. 13 & 19)

December 12, 2011 — FDA Public Meeting on Generic Drug User Fees (Dec. 19)

December 2, 2011 — CMS Open Door Forum on Final Medicare Shared Savings/ACO Rule (Dec. 7)

November 30, 2011 — New CMS Demonstration Programs Target Medicare Improper Payments

November 29, 2011 — CMS Hosts Orlando Symposium on Empowering Minorities (Dec. 14-16)

November 29, 2011 — FY 2013 IPPS New Technology Payment Town Hall Meeting (Feb. 14, 2012)

November 22, 2011 — Hospital Value Based Purchasing National Provider Call

November 21, 2011 — CMS Call on IRF Quality Reporting (Nov. 29)

November 7, 2011 — CMS Schedules Two Educational Events on Medicare Shared Savings Program/ACO Rule (Nov. 10 & Nov. 15).

October 28, 2011 — Upcoming MedPAC Meeting (Nov. 3-4)

October 27, 2011 — CMS Call on ICD-10 Implementation Strategies and Planning (Nov. 17)

October 27, 2011 — CMS Call on SNF PPS MDS 3.0 and RUG-4 (Nov. 3)

October 11, 2011 — CMS Call on ACA Comprehensive Primary Care Initiative (Oct. 13)

September 29, 2011 — CMS ACO Learning Session in Baltimore (Nov. 17-18)

September 29, 2011 — CMS Call: Revalidation of Medicare Provider Enrollment (Oct. 27)