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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

Tuesday, July 19, 2016

CMS to calculate new payment rates for lab tests

If your practice has an office laboratory, a new final rule issued by the Centers for Medicare & Medicaid Services (CMS) may affect you.

The rule requires that certain clinical labs report how much they receive from private insurers for lab tests as well as lab test volumes. CMS plans to use this information to calculate new Medicare payment rates under the Clinical Laboratory Fee Schedule (CLFS), beginning in 2018.

Only labs that receive at least $12,500 a year in Medicare revenues from laboratory services paid under the CLFS and more than half of their Medicare revenues from laboratory and/or physician services will have to report.

CMS estimates this will include only 5 percent of physician office labs and about half of independent labs. However, the information provided by those labs will help revise Medicare payment rates for everyone.

Under the plan, the affected labs will collect payer data from the first six months of this year and report it to CMS between Jan. 1 and March 31 of next year. CMS will then calculate the new Medicare rates, based on a weighted median of private payers for each test, and post them in early November 2017. They will go into effect Jan. 1, 2018.

For more information, see the CMS press release and detailed fact sheet.

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

Thursday, July 14, 2016

CMS looks to reduce 2016 meaningful use reporting period to 90 days

The Centers for Medicare & Medicaid Services (CMS) has proposed reducing the amount of time physicians and practices need to report to comply with the meaningful use (MU) program.

Originally, eligible professionals and eligible hospitals needed to report a full year’s worth of data from their electronic health records (EHRs) to meet the 2016 requirement and avoid a financial penalty.

But as part of a group of proposed policy and payment changes released earlier this month and published in the Federal Register this week, CMS says it would require those parties to submit data for any continuous 90 days between Jan. 1 and Dec. 31 of this year.

“We believe it would continue to assist health care providers by increasing flexibility in the program,” CMS said in a release, noting this is the same reporting period as in 2015.

CMS also said that physicians and hospitals who have not successfully attested to MU in a previous year would have to meet modified Stage 2 requirements by Oct. 1, 2017, instead of Stage 3.

Also, certain eligible professionals who have not successfully demonstrated MU in a previous year, plan to attest to MU in 2017, and plan to report data for the advancing care information performance category under the Merit-Based Incentive Payment System (MIPS) in 2017 can apply for a significant hardship exception from payment penalties in 2018.

CMS is accepting comments on the proposed rule though Sept. 6 before releasing a final rule.

If you don’t want to read the full proposed rule, CMS released a more succinct fact sheet

Monday, July 11, 2016

CMS releases proposed rule on 2017 Medicare physician fee schedule

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule on the 2017 Medicare physician fee schedule. Primary care physicians should be interested that the rule includes several proposed increases for care management services. Specifically, CMS is proposing to pay for:

•    Non-face-to-face prolonged evaluation and management services
•    Comprehensive assessment and care planning for patients with cognitive impairment
•    Primary care practices to use interprofessional care management resources to treat behavioral health conditions
•    Resource costs of furnishing visits to patients with mobility-related impairments
•    Chronic care management (CCM) for patients with more complex conditions

In addition, CMS proposes to reduce the administrative burden associated with the CCM codes to encourage more practices to furnish and bill for these services. CMS also will revalue existing codes describing face-to-face prolonged services.

For 2017, CMS estimates the conversion factor to be $35.7751, which is slightly lower than the 2016 conversion factor of $35.8043. However, CMS expects that the provisions of the proposed rule will generate an estimated 3 percent increase in Medicare allowed charges for family physicians. That would be the largest estimated update for a given specialty.

For individuals who don’t want to read the proposed rule itself, CMS has provided an abbreviated fact sheet and press release. CMS is accepting comments on its proposals through Sept. 6.

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

Thursday, July 7, 2016

JW modifier allows physicians to get paid for some discarded drugs

The Centers for Medicare & Medicaid Services (CMS) recently revised its guidance on how to use the JW modifier. Specifically, the revision will make it easier for physicians to get paid for leftover medication or biologicals that are properly thrown out.

Beginning Jan. 1 of next year, physicians must use the JW modifier for claims with unused drugs or biologicals from single-use vials or single-use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals). The physician must also document the discarded drug or biological in the patient's medical record when submitting Part B claims.

For example, imagine you administer 95 units of a drug from a single-use vial that is labeled to contain 100 units and discard the remaining five units. You bill the 95-unit dose on one line of the claim and bill the discarded five units on another line by using the JW modifier. Both line items would be processed for payment. You apply the JW modifier only to the amount of drug or biological that is discarded.

You may not use the JW modifier when the billing unit is equal to or greater than the total actual dose and the amount discarded. For example, if one billing unit for a drug is 10 mg in a single-use vial and you administer 7 mg and discard the remaining 3 mg, you can bill the 7 mg dose as one 10 mg unit. You could not also bill the discarded 3 mg on a separate line item with the JW modifier because that would result in overpayment.

Medicare administrative contractors currently have discretion over whether to require the JW modifier for any claims with discarded drugs or biologicals, and how the discarded drug or biological information should be documented. CMS is revising this policy to create more uniformity for these types of claims.

For additional information on billing Medicare for discarded drugs and biologicals, see section 40 of chapter 17 of the Medicare Claims Processing Manual.

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

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