CMS is hosting a call on November 1, 2016 to discuss how physicians and other providers can report quality measures during 2016 to maximize participation in Medicare quality programs, including the Physician Quality Reporting System (PQRS), Medicare Electronic Health Record (EHR) Incentive Program, Value-Based Payment Modifier (Value Modifier), and the Medicare Shared Savings Program.
Physician Quality Reporting System (PQRS)
CMS Call on 2016 PQRS Reporting & Avoiding 2018 Negative Payment Adjustments (April 21)
On April 21, 2016, CMS is hosting a provider call on the 2016 Physician Quality Reporting System (PQRS), including how eligible professionals and group practices can satisfactorily participate and report in order to avoid the 2018 PQRS negative payment adjustment. Registration is required to participate.
CMS Call: 2016 Medicare Physician Quality Reporting Programs (Dec. 8)
On December 8, 2015, CMS is hosting a call to discuss how the 2016 Medicare Physician Fee Schedule final rule impacts Medicare quality reporting programs. Specifically, the call will address changes to the Physician Quality Reporting System, the Electronic Health Record Incentive Program, the Comprehensive Primary Care initiative, the Value-Based Payment Modifier, the Medicare Shared…
CMS Finalizes Medicare Physician Fee Schedule Rates, Policies for 2016
Today the Centers for Medicare & Medicaid Services (CMS) published the final rule to update the Medicare physician fee schedule (MPFS) for calendar year (CY) 2016. Despite the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) establishing a 0.5% conversion factor (CF) update for 2016, the final 2016 CF of $35.8279 actually is a decrease compared to the 2015 CF of $35.9335. This is because CMS has more than offset the 0.5% MACRA update with a -0.02% budget neutrality adjustment in addition to a -0.77% “target recapture amount” to reach a statutory target for savings achieved from misvalued code adjustments (discussed below). Final rates and policies are effective January 1, 2016, with certain exceptions. CMS is accepting comments until December 29, 2015 on a limited number of provisions of the rule (e.g., interim final work, practice expense, and malpractice RVUs; interim final new, revised, potentially misvalued HCPCS codes; and changes to the physician self-referral list of codes). The sweeping rule includes numerous policy provisions, including the following:
Continue Reading CMS Finalizes Medicare Physician Fee Schedule Rates, Policies for 2016
CMS Schedules Provider Calls on Medicare Quality Programs
CMS is hosting several calls and webcasts in September and October 2015 on various Medicare quality programs, including the following:
- A September 17 webcast/call will focus on the 2014 Annual Quality and Resource Use Reports (QRURs) that the agency is making available to group practices and solo practitioners nationwide. CMS will hold a separate call
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Proposed CY 2016 MPFS Rule Takes First Steps in Implementing MACRA Reforms
On July 15, 2015, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare physician fee schedule (MPFS) for CY 2016 – the first rulemaking since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the sustainable growth rate (SGR) formula. Under the proposed rule, the 2016 MPFS conversion factor (CF) would be $36.1096, compared with the 2015 CF of $35.9335, reflecting a 0.5% update factor specified under MACRA and a budget neutrality adjustment of 0.9999. Note that the CF is subject to change in the final rule, however, if CMS does not meet a statutory target for expenditure reductions related to its review of misvalued procedures (discussed below). The proposed rule addresses numerous aspects of Medicare Part B and other CMS program policies. Highlights include the following:
Continue Reading Proposed CY 2016 MPFS Rule Takes First Steps in Implementing MACRA Reforms
CMS Invites Suggestions for Potential PQRS Measures
CMS is soliciting quality measure suggestions for potential use in the Physician Quality Reporting System (PQRS) and other quality programs in future years. Measures submitted by June 15, 2015 may be considered for inclusion on the 2015 Measures Under Consideration (MUC) list for implementation in PQRS as early as 2017. CMS notes that it will…
CMS Call on Physician Quality Reporting Programs (March 18)
On March 18, 2015, CMS is hosting a call to discuss how providers may report once across various 2015 Medicare Quality Reporting Programs, including the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record (EHR) Incentive Program, the Value-Based Modifier (VM) program, and the Medicare Shared Savings Program. Providers that satisfactorily report will avoid…
CMS Call: Medicare Quality Reporting Programs: Data Submission Process (Jan. 13)
On January 13, 2015, CMS is hosting a national provider call to provide an overview of the 2014 submission process for Medicare quality reporting programs, including the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier, and the Electronic Health Record Incentive Program. This session will discuss how eligible professionals and PQRS group practices can earn…
CMS Publishes Final 2015 Medicare Physician Fee Schedule Rule for 2015
On November 12, 2014, CMS published its final rule to update the Medicare physician fee schedule (MPFS) for CY 2015. Highlights of the sweeping rule include the following:
- The Protecting Access to Medicare Act (PAMA) of 2014 provides for a 0% update to the conversion factor (CF) for MPFS services furnished between January 1, 2015 and March 31, 2015, with the CF adjusted afterwards according to the statutory Sustainable Growth Rate (SGR) formula. In the final rule, CMS determined that based on the zero percent update under PAMA and adjustments necessary to maintain budget neutrality, the CF for the first quarter of 2015 will be $35.8013 (compared to $35.8228 in 2014). CMS also announced that the CF for April 1, 2015 through December 31, 2015 will be $28.2239 – a 21.2% reduction — unless Congress establishes an alternative CF or otherwise modifies the SGR formula. While there is an expectation that Congress eventually will override this payment cut, the form any such action might take is speculative at this point.
Continue Reading CMS Publishes Final 2015 Medicare Physician Fee Schedule Rule for 2015
CMS Call on Changes to Physician Quality Reporting Programs for 2015 (Dec. 2)
On December 2, 2014, CMS is hosting a provider call to discuss changes to the Medicare physician quality reporting programs in the 2015 Medicare Physician Fee Schedule final rule. Among other things, the call will cover changes impacting the Physician Quality Reporting System (PQRS), Value-based Payment Modifier, Physician Compare, Electronic Health Record (EHR) Incentive Program,…
CMS Solicits Suggestions for Potential PQRS Measures
CMS is inviting quality measure suggestions for potential use in the Physician Quality Reporting System (PQRS) and other physician quality programs. Measure suggestions will be accepted on an ongoing basis, with measures submitted prior to June 15, 2015 eligible to be considered for inclusion in the PQRS as early as 2017.
CMS Call: How to Avoid 2016 Negative Payment Adjustments under Medicare Quality Reporting Programs
On September 17, 2014, CMS is hosting a call on negative payment adjustments that could apply under several Medicare quality reporting programs in 2016. Specifically, the call will offer instructions on how eligible professionals and group practices can avoid the 2016 Physician Quality Reporting System negative payment adjustment, satisfy the clinical quality measure component of…
CMS Publishes Proposed MPFS Rule for 2015
On July 11, 2014, CMS published its proposed rule to update the Medicare physician fee schedule for CY 2015. The proposed rule reflects enactment of the Protecting Access to Medicare Act (PAMA) of 2014, which provides for a 0% update to the conversion factor (CF) for MPFS services furnished between January 1, 2015 and March 31, 2015. In the Proposed Rule, CMS estimates that with the application of a budget neutrality adjustment, the CF for the first quarter of 2015 would be $35.7977 (compared to $35.8228 in 2014). Under PAMA, the CF will be adjusted on April 1, 2015 according to the Sustainable Growth Rate (SGR) formula unless Congress takes additional legislative action. CMS does not speculate on the CF that will be applicable April 1, 2015 through December 31, 2015, but CMS previously estimated that the SGR would result in about a 20.9% cut in MPFS payments for 2015 if Congress does not again intervene. There is an expectation that Congress eventually will override this payment cut, but the timing and extent of any such relief cannot be assured at this time. Other key provision in the proposed rule include the following:Continue Reading CMS Publishes Proposed MPFS Rule for 2015
GAO Offers Recommendations for Improvements to CMS Physician Feedback Efforts
A recent GAO report looked at how private health care entities provide performance data to physicians, and how such practices could be used to improve CMS efforts to provide feedback to providers. The GAO determined that the nine health insurers and statewide collaboratives it reviewed typically employ multiple benchmarks (e.g., peer group averages or past…
CMS Issues Call for PQRS Quality Measures
On May 1, 2014, CMS will begin accepting recommendations for potential Physician Quality Reporting System (PQRS) quality measures for 2016 and future rulemaking years. Quality measure proposals also will be considered for use in other physician quality programs, including the Value Based Modifier, Physician Compare, and the Medicare Shared Savings Program.
CMS Updates Medicare Physician Fee Schedule, Other Part B Policies for CY 2014
On December 10, 2013, CMS published its final rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014, which includes a 20.1% across-the-board cut in PFS rates in 2014 (down from 24.4% projected under the proposed rule). The cuts are largely due to the statutory Sustainable Growth Rate (SGR) update formula, although lawmakers are seeking agreement on legislation to block the automatic cuts. The rule also includes a number of significant Part B policy changes, including the following highlights:
Continue Reading CMS Updates Medicare Physician Fee Schedule, Other Part B Policies for CY 2014
CMS Call on Medicare Physician Quality Reporting in 2014 (Dec. 17)
On December 17, 2013, CMS is hosting a call to provide an overview of the quality reporting provisions in the 2014 Physician Fee Schedule (PFS) final rule (which has not yet been released). The call will provide details on how an eligible professional or group practice can meet the criteria for satisfactory reporting for the…
CMS Call Regarding the Medicare Physician Value-Based Payment Modifier (Dec. 3).
On December 3, 2013, CMS will host a National Provider Call to provide an overview of the value-based payment modifier (VM) under the final 2014 Medicare Physician Fee Schedule final rule (which has not yet been released). CMS will also describe how the VM is aligned with the reporting requirements under the Physician Quality Reporting…
CMS Proposes Updates to Medicare Physician Fee Schedule, Other Part B Policies for CY 2014
On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule updating Medicare physician fee schedule (PFS) rates and polices for calendar year (CY) 2014. CMS projects that PFS payments will be reduced by approximately 24.4% in 2014, largely due to the statutory Sustainable Growth Rate (SGR) update formula (although Congress is expected to eventually take action to block the automatic cuts, as it has in the past). The rule also includes a number of significant policy proposals, including the following highlights:Continue Reading CMS Proposes Updates to Medicare Physician Fee Schedule, Other Part B Policies for CY 2014