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Wednesday, November 2, 2016

How to avoid E/M errors and denials

The Centers for Medicare & Medicaid Services (CMS) says approximately 15 percent of evaluation and management (E/M) services are improperly paid and accounted for 9.3 percent of the overall Medicare fee-for-service improper payment rate in 2014. To help you avoid improper payment of your E/M claims and prevent payment denials, CMS has released a new fact sheet of compliance tips for E/M services.

According to the fact sheet, E/M claims are typically denied for two reasons: incorrect coding, such as the code not matching the documentation, and insufficient documentation, which can include a lack of a physician signature or no record of the extent and amount of time spent in counseling and/or coordination of care when it is used to qualify for a particular level of E/M service.

To prevent your E/M claims being denied, CMS recommends a number of strategies. First, in addition to the individual requirements for billing a selected E/M code, you should also consider whether the service is “reasonable and necessary.” For example, while it is possible to provide and document a level 5 office visit for a patient with a common cold and no comorbidities, it is unlikely that anyone would consider that level of service reasonable and necessary under those circumstances.

Another strategy is to remember the following key variables when selecting codes for E/M services:
•    Patient type (new or established)
•    Setting/place of service
•    The level of service provided based on the extent of the history, the extent of the examination, and the complexity of the medical decision making (i.e., the number and type of the key components performed)

Finally, the fact sheet emphasizes the need to obtain the necessary physician/non-physician provider signatures. You can find links to additional CMS resources and references at the end of the fact sheet.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Monday, October 31, 2016

Comprehensive Primary Care Plus program reopening to practices

Practices that missed the application deadline for the Comprehensive Primary Care Plus (CPC+) program will have another opportunity to apply next year.

The Centers for Medicare & Medicaid Services (CMS) recently announced it was reopening CPC+ applications for both payers and practices. Delays in the initial payer application process this summer shrunk the two-month practice application window by two weeks. Many practices felt this was not sufficient time to evaluate the program and determine if the added payment associated with CPC+ would support the amount of work necessary to comply with the program. 

In addition, at that time only one region in the original Comprehensive Primary Care initiative had achieved shared savings, which led some to believe it was not a successful program. On Oct. 17, CMS announced that four of the seven participating regions experienced net savings for 2015, the program’s second performance year.

The CPC+ program is one of the payment models recognized as an Advanced Alternative Payment Model (APM) in the final rule of the Quality Payment Program (QPP), part of the Medicare Access and CHIP Reauthorization Act. Participation in an Advanced APM offers physicians the opportunity to receive a 5 percent bonus payment.

CMS has not yet provided additional details on next year’s reopening of the CPC+ application process. In the meantime, you can learn more about the CPC+ application requirements by reviewing the original Request for Applications.

Kristen A. Stine, MSOD, Practice Transformation Strategist at the American Academy of Family Physicians

Friday, October 21, 2016

Some tips on MIPS included in the final MACRA rule

By now, you may have seen that the Centers for Medicare & Medicaid Services (CMS) has released a final rule that implements the Medicare Quality Payment Program (QPP) called for in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Most of this regulation is final and effective Jan. 1, but CMS seeks comments on some sections.

Meanwhile, here are some highlights for the Merit-based Incentive Payment System (MIPS) portion of the rule:

•    Eligible clinicians only need to score three points and report as little as one measure to avoid a negative payment adjustment in 2019. Eligible clinicians who achieve a final score of 70 or higher will be eligible for the exceptional performance adjustment, funded from a pool of $500 million.
•    Eligible clinicians only need to report for a minimum of 90 consecutive days in 2017 to be potentially eligible for a small upward payment adjustment in 2019, which means you can start reporting as late as Oct. 2, 2017.
•    CMS is decreasing the number of measures eligible clinicians must report.
•    CMS estimates that more than 90 percent of eligible clinicians will receive a positive or neutral payment adjustment in 2019.

Although CMS is still not offering small practices a “virtual group” option under MIPS, there was good news for these physicians. For instance, CMS is excluding more small practices from being subject to MIPS by raising the “low-volume threshold” for exclusion to be $30,000 or less in Medicare Part B allowed charges and 100 or fewer Medicare patients. CMS also estimates that at least 80 percent of solo practices and groups with nine or fewer clinicians will receive either a positive or no MIPS payment adjustment in 2019.

To accompany the final rule and provide more information, CMS also launched a new QPP website and issued an executive summary, press release, blog post from Acting CMS Administrator Andy Slavitt, and fact sheet about the regulation. A family medicine perspective on the final rule is also available.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Tuesday, October 11, 2016

New limited English proficiency rule to start Oct. 17

Sometimes, “getting paid” means implementing regulations as cheaply as possible without running afoul of the law. Such is the case with a federal rule that goes into effect next week.

Beginning Oct. 17, the U.S. Department of Health and Human Services (HHS) will require most physician practices to notify patients with limited English proficiency (LEP) of their freedom from discrimination and of the availability of language assistance services. This rule applies to all health programs or activities that receive funding from or are administered by HHS and the health insurance marketplaces as well as all plans offered by issuers that participate in those marketplaces. For instance, if you receive Medicaid payments or a “meaningful use” incentive payment, this rule applies to you. However, if your practice’s only source of federal funds is through Medicare Part B, then this rule does not apply to you.

To comply with the rule, your practice must ensure “meaningful access” for those with LEP by adhering to the following requirements:

•    You must post a notice of nondiscrimination in English and may combine the content of the notice with other notices required under other federal laws.
•    You must post taglines written in the top 15 languages in the state where your practice does business indicating that language assistance is available. HHS has determined the top 15 languages for each state. Ideally, the language of the tagline should be in the language to which it refers; HHS has translated resources on its website.

You must post the notices in a sufficiently prominent and noticeable place in your office, and the rule requires that you post the language assistance taglines on all “significant publications or communications.” This means items that would result in substantial consequences if the patient did not understand (e.g., notice of a treatment plan or a termination of coverage). If the publication or communication is electronic, it must have a link to the notice of nondiscrimination and 15 taglines on the bottom. If it is paper, the publication must have the statement of nondiscrimination and taglines, unless it is something small, like a postcard. In those cases, it only needs the statement of nondiscrimination and the tagline in the top two languages. The notice of nondiscrimination and top 15 taglines should also be at the bottom of your website.

If you have not already done so, now would be a good time to develop a plan to address the needs of patients with LEP. Ideally, the plan should include all languages frequently used in the practice, even if they are not included in the top 15 languages in your state. You may also consider signing up with a language assistance call center to help with the translation of documents as well as telephonic or in-person interpretation when needed. For example, some states’ Medicaid programs regard medical interpretation as a covered service and contract with a vendor to provide it. Your local hospital may also have interpreter resources. Finally, you should consider having commonly used documents translated for frequently used languages.

Enforcement of the new rule will fall to HHS’s Office of Civil Rights, which has indicated that it will use a flexible, context-specific analysis to determine any violations on a case-by-case basis. For additional information, check out the HHS summary and fact sheets and training materials .

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, September 30, 2016

See if you’re due a penalty in the 2015 PQRS physician feedback report

Individual physicians and groups can now access their 2015 Physician Quality Reporting System (PQRS) Physician Feedback reports, which provide valuable information about your practice and whether you will face a Medicare penalty in 2017.

Physicians can access the reports through the CMS Enterprise Portal. Users must have an Enterprise Identity Management (EIDM) account with the appropriate role to access the reports. You can also access your Quality and Resource Use Reports (QRUR), which were also recently released, through the same portal.

The Physician Feedback reports will provide the determination on whether you met the PQRS criteria to avoid a 2 percent negative payment adjustment in 2017. Information is available for all measures reported by your National Provider Identifier (NPI) for each reporting method. You can review if your successfully reported all your measures and see a brief rationale for any payment adjustment, such as insufficient measures reported. It also includes reporting rate and performance rate percentages.

You can file an informal review request if you feel the negative payment adjustment was an error. The informal review period is open until Nov. 30. Reviews can be filed through the Quality Reporting Communication Support Page. For more information or additional questions, contact the QualityNet Help Desk at qnetsupport@hcqis.org or (866) 288-8912. A Feedback Report User Guide is available online.

The Centers for Medicare & Medicaid Services will mail out payment adjustment notification letters at a later date. Accessing the Physician Feedback reports now will allow you to review your performance and file an informal review before the deadline.

– Erin Solis, Regulatory Compliance Strategist at the American Academy of Family Physicians

Wednesday, September 28, 2016

QRUR reports for 2015 now available

The 2015 annual Quality and Resource Use Reports (QRUR) are now available to all group practices and solo practitioners. The report released by the Centers for Medicare & Medicaid Services (CMS) provides data on a practice’s performance on quality and cost metrics. The QRUR also provides information on how the practice fared under the 2017 Value-Based Payment Modifier (VBPM).

Authorized representatives can access the QRUR through the CMS Enterprise Portal with their Enterprise Identity Data Management (EIDM) credentials. You must have the correct role within the EIDM to access the report. CMS has provided guides on obtaining an EIDM account and how to obtain a QRUR.

Physicians will find in the reports performance information on the measures they submitted to the Physician Quality Reporting System (PQRS). CMS also calculates several claims-based quality and cost measures. Along with the QRUR, you can download an Excel file containing provider- and patient-level data. The information provided in the spreadsheets allows physicians to identify areas for improvement in cost and quality performance.

In 2017, all solo- and group-eligible professionals will be subject to the VBPM. Payment adjustments for the VBPM depend on practice size. It is important to review the information in the QRUR for accuracy. If you feel you have been assessed a payment penalty incorrectly, you can file an informal review through Nov. 30. You can submit a review through the CMS Enterprise Portal, or you can contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3). The help desk is available by phone Monday-Friday 8 a.m.-8 p.m. EST.

Becoming familiar with the QRUR now is important as it will continue in some form under the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA's Merit-Based Incentive Payment System (MIPS) incorporates elements of PQRS and the VBPM. The initial performance period is slated to begin in 2017.

– Erin Solis, Regulatory Compliance Strategist for the American Academy of Family Physicians

Tuesday, September 27, 2016

Survey shows troublesome practice environment could affect patient access

Negative opinions about the state of medicine has large numbers of physicians planning to change their practices in ways that would decrease access to patients, according to a new study by The Physicians Foundation and Merritt Hawkins.

Almost half of the more than 17,000 physicians surveyed this spring said they planned over the next one to three years to cut back on hours worked, retire, take a non-clinical health care position, switch to a cash-only practice, or take other steps that would ultimate reduce access to patients.

"(The survey) reveals a physician workforce that continues to be dispirited about the current state of the medical profession and apprehensive about its future, due primarily to the large regulatory burden physicians face and the perceived erosion of their clinical autonomy," the researchers said in the report.

Overall, only 52 percent of physicians said they planned to remain working at the same level they are now. That represents a decline from 2014 when 56 percent of physicians surveyed said they didn't plan to change their practice.

The reasons for the negative changes are widespread. Almost 63 percent of respondents said they felt either "very" or "somewhat" pessimistic about the future of medicine, which was an increase from 51.1 percent in 2014. Eighty-one percent of physicians said they were overextended or at full capacity and unable to see more patients.

That said, many physicians aren't ready to abandon medicine entirely. Almost 72 percent of respondents said they would choose medicine as a career again, compared with 71 percent in 2014 and 67 percent in 2012. When asked if they would still recommend medicine as a career to their children or other young people, 51 percent said they would, up slightly from 50 percent in 2014.

Primary care physicians were a little more optimistic than their specialist peers, with 50.5 percent saying they are very or somewhat positive about the current state of medicine and 42.5 percent positive about the future of medicine. By comparison, 43.5 percent of specialists were positive about the present and 33.9 percent were positive about the future of medicine. Almost 73 percent of primary care physicians said they would choose medicine again as a career, compared with 71.4 percent of specialists, and 54 percent of primary care physicians said they would recommend medicine as a career to young people, compared with 50 percent of specialists.

The demographics of those responding to the survey showed the continuing trend of physicians leaving private practice for employed positions. Almost 33 percent characterized themselves as practice owners while about 58 percent said they worked for a hospital or large medical group. By comparison, 35 percent identified as practice owners in 2014 and 53 percent worked for large health groups and hospitals.

Looking at specific pieces of health care reform, only 43 percent said they were paid based on quality or value and 80 percent professed little knowledge of the Medicare Access and CHIP Reauthorization Act (MACRA). Only 11 percent of respondents said electronic health records have improve their interactions with patients, and only between 5 percent and 6 percent said the year-old ICD-10 coding has improved efficiency and revenues.

Wednesday, September 21, 2016

Codes for smoking and tobacco cessation counseling are changing

As part of its quarterly update to the Medicare physician fee schedule database, the Centers for Medicare & Medicaid Services (CMS) is changing the way you report smoking and tobacco cessation counseling to Medicare.

Effective for services on or after Oct. 1, CMS will no longer consider valid for Medicare purposes CPT codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes).

CMS has advised its Medicare contractors to replace codes G0436 and G0437 with CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes). Additional information on Medicare coverage of such counseling is discussed in Section 210.4.1 of the Medicare National Coverage Determination Manual.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, September 15, 2016

Grace period for ICD-10 coming to an end

We’ve almost completed a full year of ICD-10-CM use. Congratulations! The world didn’t stop turning on its axis; the sun didn’t explode. Now, we are ready for the next hurdle related to ICD-10: The end of the “grace period” extended by the Centers for Medicare & Medicaid Services (CMS).

What was the “grace period?" It was a 12-month period, beginning Oct. 1, 2015, during which CMS processed and paid any Medicare claim submitted with a valid ICD-10 code that was at least within the family (the first three digits) of the diagnosis in question. This period is ending Sept. 30 of this year, after which CMS and its contractors will require the diagnostic codes you submit to reflect documentation and be specific to the patient and condition.

What codes should you be wary of using? “Unspecified,” “NOS,” and “not otherwise specified” codes will gain particular scrutiny from CMS. These codes will often have the digit “9” as the fourth or sixth character.  

How do you determine if your coding is safe? This answer is a two-parter. First, you need to evaluate which ICD-10 codes you are submitting most often on your claims. When I was in clinic, my family doctors thought they used certain codes often. But after I ran reports to show which ones they actually used, they were often surprised. Running a report of your top 25, 50, or 100 ICD-10 codes will help you determine how often you are using unspecified codes and where you need to concentrate on being more specific. Second, make sure you monitor your Medicare administrative contractor’s Local Coverage Determination (LCD) policies and CMS’s National Coverage Determination (NCD) policies. These polices list the covered diagnoses for specific services you may be performing, ordering or referring. Familiarize yourself with these policies. It will save you and your staff time and heartaches – and maybe a few claim denials, too.

Where can I go to learn more? CMS has published frequently asked questions and other resources about ICD-10.

– Barbie Hays, CPC, CPMA, CPC-I, CEMC, Coding and Compliance Strategist for the American Academy of Family Physicians

Friday, September 9, 2016

CMS will let you pick your pace for MACRA compliance

Apparently acknowledging criticism that the timetable for physicians to participate in the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) next year may be too fast for some, the Centers for Medicare & Medicaid Services (CMS) is giving you some options.

In a blog post this week, Acting CMS Administrator Andy Slavitt laid out the four options, which let physicians and other providers pick the pace of their participation in the first performance period that begins Jan. 1. Choosing one of these options would ensure you do not receive a Medicare payment cut in 2019.

The first option is more of a test of the Quality Payment Program, allowing you to avoid the 2019 payment penalty if you submit at least some data after Jan. 1. The idea is that you will show your system is operating and prepared for broader participation in 2018 and 2019.

The second option is participating for part of 2017 as opposed to an entire calendar year. For example, Slavitt writes, you could submit data for a period starting later and Jan. 1 for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking. and still qualify for a small payment bonus.

If your practice was already expected to be prepared to participate fully in the Quality Payment Program on Jan. 1, you can take option three, which has you submitting a full calendar year of data for the program and qualifying for a modest positive payment adjustment.

The final option is to ignore submitting quality data and other information entirely and join an Advanced Alternative Payment Model in 2017, as provided in MACRA. Physicians who meet the required level of Medicare payments or patients through this alternative model would qualify for a 5 percent incentive payment in 2019.

CMS will provide more details about these options and the Quality Payment Program in general when it releases its final rule on MACRA implementation by Nov. 1.  

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, September 2, 2016

Understanding what Medicare expects when ordering diabetes supplies

Sometimes, it’s not about getting paid. Sometimes, it’s about getting your patients what they need with the least amount of hassle and paying yourself with the time saved.

One of the ongoing sources of frustration for family physicians is helping their Medicare patients with diabetes receive the testing supplies they need to help manage their condition. Physicians have to continually order refills even though they know the patients will need to test for the rest of their lives and have to specify the brand name of the products they are ordering even though, from a clinical standpoint, the name of the brand doesn’t matter. Apparently, “diabetic testing supplies” is inadequate for Medicare purposes.

So, what do the Medicare administrative contractors (MACs) that process claims for glucose monitors and related supplies (e.g. lancets and test strips) expect from physicians? One of the MACs recently attempted to address that question.

For glucose monitors, Medicare requires the following prior to delivery by a supplier:

•    A face-to-face visit with the prescribing practitioner within six months before prescribing, including documentation that the patient was evaluated, treated or both for diabetes mellitus supporting need for the glucose monitor ordered,
•    An order that includes:
     o    Patient name
     o    Item ordered
     o    National Provider Identifier
     o    Date of the order
     o    Prescribing practitioner signature

Other diabetes testing supplies, such as test strips and lancets, require a detailed written order to the supplier. The detailed written order must contain:

•    Beneficiary's name
•    Prescribing practitioner’s name
•    Date of the order
•    Detailed description of the item(s)
•    Frequency of use or testing
•    Quantity to be dispensed
•    Number of refills
•    Prescribing practitioner’s signature and signature date

Be aware that there are limits to the quantity of test strips and lancets that Medicare covers when the basic coverage criteria are met. For beneficiaries treated with insulin, this limit is 300 every three months. For beneficiaries not receiving insulin, the limit is 100 every three months.

Medicare will cover quantities above these limits, but you have to document additional criteria in your patient’s medical record and be prepared to make that documentation available upon request. These additional documentation requirements are that you have seen and evaluated the beneficiary’s diabetes within six months of ordering supplies in excess of the normal amounts and have documented in the medical record the specific reason for the additional supplies. Also, you need:

•    Medical records documenting frequency of actual testing by beneficiary;
•    Specific narrative that documents frequency beneficiary is actually testing; or
•    Copy of the beneficiary’s testing log (must be provided to physician by beneficiary).

This guidance will not solve all of the hassles associated with getting your Medicare patients with diabetes the testing supplies they need. However, if it helps you get your patients the items they need faster, then so much the better for you, them, and Medicare. 

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Friday, August 19, 2016

CMS clarifies the new lab reporting requirement

Last month, we highlighted a new rule from Medicare that requires certain clinical labs to report how much they receive from private insurers for lab tests. Now, the Centers for Medicare & Medicaid Services (CMS) has issued guidance to help labs meet the new requirements by clarifying some of the who, what, and when related to the new rule.

With respect to “who,” labs can use a four-question test to determine if the new rule applies to them:

• Is the lab certified under the Clinical Laboratory Improvement Amendments (CLIA)?
• Does the CLIA-certified lab bill Medicare Part B under its own national provider identifier?
• Does the lab meet the majority of Medicare revenues threshold?
• Does the lab meet the low expenditure threshold?

To answer “what,” CMS lays out the three major types of information that affected labs must collect and report:

• The specific billing code associated with a test
• The private payer rate for each test for which final payment has been made during the data collection period
• The associated volume for each test

Finally, in terms of “when,” the guidance defines the first data collection and reporting periods:

• Labs affected by the rule must collect applicable information from all claims for which the lab received final payment between Jan. 1 and June 30 of this year.
• Labs must submit that information to CMS between Jan. 1 and March 31 of next year.

During the six-month window between the end of the data collection period and the beginning of the data reporting period, CMS expects laboratories and reporting entities to assess whether the applicable laboratory thresholds are met.

As noted in our original post, CMS estimates this new rule will include only 5 percent of physician office labs and about half of independent labs. For those that fall in that category, the new guidance is essential reading.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, August 11, 2016

It’s not too early to prepare for diagnosis code changes

Changes are coming to the ICD-10-CM code set. Effective with services provided on or after Oct. 1, ICD-10 diagnosis codes will update to the 2017 version.

The update will affect some of the diagnosis codes used in family medicine. For instance, one of the most significant changes is the addition of a new code, R73.03, for “Prediabetes.” Another example is coding for “familial hypercholesterolemia.” If you had to code that today, you would use E78.0 (Pure hypercholesterolemia). The 2017 version of ICD-10 replaces E78.0 with two new options:

•    E78.00 (Pure hypercholesterolemia, unspecified)
•    E78.01 (Familial hypercholesterolemia)

Similarly, ICD-10 is adding three new codes to report joint pain in the hands:

•    M25.541 (Pain in joints of right hand)
•    M25.542 (Pain in joints of left hand)
•    M25.549 (Pain in joints of unspecified hand)

These are just some of the changes relevant to family medicine. Crosschecking the diagnosis codes you use most often (e.g., the ones listed on your superbill) against the 2017 ICD-10-CM code set would be a good place to start in preparing for the update.

You can access the new ICD-10 code set and other related resources through the Centers for Medicare & Medicaid Services ICD-10 web site. The American Academy of Family Physicians also has ICD-10 resources on its web site, including AAFP Coding Flashcards for 2017.

Diagnosis code changes are coming. Are you ready?

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Thursday, August 4, 2016

Comprehensive Primary Care Plus regions announced

Back in April, the Centers for Medicare & Medicaid Services (CMS) unveiled its latest model of practice transformation and primary care delivery, Comprehensive Primary Care Plus (CPC+). This new model is available only for a limited time and in limited areas – but those areas have finally been announced.

CMS has selected 10 states (Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee) and four more specific regions (the Greater Kansas City region in Missouri and Kansas, the North Hudson-Capital region of New York, a region covering all of Ohio and northern Kentucky, and the Greater Philadelphia region of Pennsylvania).

CMS chose these regions based on the 57 commercial payers who CMS selected to participate in the program and who wil support CMS’s payment model. A full list of participating payers by region can be downloaded on the CMS CPC+ webpage. CPC+ is expected to involve up to 5,000 practices and more than 20,000 physicians and other clinicians serving up to 25 million patients.

Individual physicians and practices in the designated regions can apply to participate through the CPC+ Online Application Portal through Sept. 15. Practice application questions can be found in the Request for Applications.

CMS is offering additional answers to CPC+ Practice Frequently Asked Questions and webinars called Open Door Forums focused on various CPC+ program topics. The AAFP is also partnering with Caravan Health to help practices prepare for the requirements of CPC+ through Caravan Health's Boot Camp.

Physicians participating in the five-year program, which is scheduled to begin Jan. 1, must choose one of two tracks focused on care management, access and continuity, planned care for population health, patient and family caregiver engagement, and care that is comprehensive and coordinated.

While Track 1 requirements are similar to the original CPC program’s milestones, Track 2 forces participants to push the envelope in terms of using health information technology, targeting patients with complex needs, and helping meet patients’ psychosocial needs.

Physicians participating in CPC+ will receive monthly care management fees for eligible beneficiaries in their practice. Physicians in Track 1 will be paid depending on where each patient falls across four risk tiers, with an average of $15 per beneficiary per month. In Track 2, physicians will be paid according to five risk tiers, with an average of $28 per beneficiary per month, including $100 per month for the most complex patients. Practices can use these fees for increased staffing and training necessary to meet the model’s patient care requirements.

In addition to the care management fees, Track 1 physicians will continue to receive their normal Medicare fee-for-service payments. Physicians in Track 2 will receive a new hybrid of fee-for-service payments and a “Comprehensive Primary Care Payment,” which will include a percentage of the expected Medicare reimbursement for Evaluation & Management (E/M) claims upfront. Reimbursement for the E/M claims themselves will be reduced.

— Kristen Stine, Practice Transformation Strategist for the American Academy of Family Physicians

Thursday, July 28, 2016

You'll need an EIDM account for this year's feedback reports

The Centers for Medicare & Medicaid Services (CMS) is encouraging physicians to sign up or reactivate their Enterprise Identity Management (EIDM) accounts now ahead of the release this fall of a pair of important feedback reports. EIDM accounts are required to access the information, and signing up now will prevent delays when the reports are released.

An EIDM account allows physicians to view and download their Physician Quality Reporting System (PQRS) feedback report and Quality and Resource Use Report (QRUR). The PQRS report provides information on your performance in 2015 and any payment adjustments for 2017. The 2015 QRUR includes information on how your practice fared on quality and cost measures as well as any payment adjustment you may receive under the Value-Based Payment Modifier. (For more information, see "What You Need to Know About Medicare's New 'Quality and Resource Use Report'," FPM, November/December 2015.)

To sign up for an account, visit the CMS Enterprise Portal website and click “New User Registration” located under the CMS Secure Portal heading. Once you’ve created your username and password, you will need to request access for the “Physician Quality and Value Programs.” From there you can select the type of role. Each organization must have at least one Security Official unless they are a solo practice, in which you would designate an Individual Practitioner. If you need assistance in signing up for an account or are unsure if you or someone in your practice already has an account, you can contact the QualityNet Help Desk at 866-288-8912.

CMS has created an EIDM System Toolkit containing guides on signing up for an account. It is a good idea to review this information before beginning the application process to make sure you have all the information you need. CMS make take several weeks to approve your role request, so it is important to begin this process as early as possible.

– Erin Solis is the Regulatory Compliance Strategist at the American Academy of Family Physicians

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